title: Factors Affecting the Efficacy of Nonsteroidal Anti-inflammatory Drugs in Preventing Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis: A Systematic Review and Meta-analysis.
abstract: OBJECTIVE
  To identify the factors affecting the efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs) in preventing post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP).
  
  
  METHODS
  We systematically searched databases for relevant studies published from inception to November 2013.
  
  
  RESULTS
  A meta-analysis of 11 randomized trials (n = 2497) revealed a significant reduction in PEP in patients who received NSAIDs compared with that in patients who received placebo (relative risk [RR], 0.59; 95% confidence interval [CI], 0.41-0.85; P = 0.005). In subgroup analysis by treatment type, indomethacin had no significant effect (RR, 0.66; 95% CI, 0.38-1.15; P = 0.14), whereas other NSAIDs showed significant benefit (RR, 0.51; 95% CI, 0.29-0.91; P = 0.02). Only rectal administration significantly reduced the incidence of PEP (RR, 0.43; 95% CI, 0.32-0.58; P < 0.00001). The risk for PEP was the lowest among patients who received NSAIDs before ERCP (RR, 0.48; 95% CI, 0.29-0.78; P = 0.003). NSAIDs did not significantly reduce the risk of PEP in men (RR, 0.61; 95% CI, 0.34-1.09), patients with sphincter of Oddi dysfunction (RR, 0.98; 95% CI, 0.38-2.54), or patients with pancreatic duct injection (RR, 0.64; 95% CI, 0.35-1.18).
  
  
  CONCLUSIONS
  Rectal administration of NSAIDs (especially diclofenac), before ERCP, seemed to be the most effective strategy for preventing PEP.
authors.affiliation: From the *Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven; and †Department of Internal Medicine, University of Connecticut Health Center, Farmington, CT.
authors.forename: Tarun
authors.initials: T
authors.lastname: Rustagi
authors.forename: Basile
authors.initials: B
authors.lastname: Njei
mesh_terms: D000285:Administration, Rectal; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage* / Q000009:adverse effects; D016009:Chi-Square Distribution; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D004008:Diclofenac / Q000008:administration & dosage* / Q000009:adverse effects; D004334:Drug Administration Schedule; D006801:Humans; D016017:Odds Ratio; D010195:Pancreatitis / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D065840:Protective Factors; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D004008:Diclofenac