title: Systematic review and meta-analysis on the prophylactic role of non-steroidal anti-inflammatory drugs to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis.
abstract: OBJECTIVE
  To critically appraise the published randomized, controlled trials on the prophylactic effectiveness of the non-steroidal anti-inflammatory drugs (NSAIDs), in reducing the risk of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis.
  
  
  METHODS
  A systematic literature search (MEDLINE, Embase and the Cochrane Library, from inception of the databases until May 2015) was conducted to identify randomized, clinical trials investigating the role of NSAIDs in reducing the risk of post-ERCP pancreatitis. Random effects model of the meta-analysis was carried out, and results were presented as odds ratios (OR) with corresponding 95%CI.
  
  
  RESULTS
  Thirteen randomized controlled trials on 3378 patients were included in the final meta-analysis. There were 1718 patients in the NSAIDs group and 1660 patients in non-NSAIDs group undergoing ERCP. The use of NSAIDs (through rectal route or intramuscular route) was associated with the reduced risk of post-ERCP pancreatitis [OR, 0.52 (0.38-0.72), P = 0.0001]. The use of pre-procedure NSAIDs was effective in reducing approximately 48% incidence of post-ERCP pancreatitis, number needed to treat were 16 with absolute risk reduction of 0.05. But the risk of post-ERCP pancreattis was reduced by 55% if NSAIDs were administered after procedure. Similarly, diclofenac was more effective (55%) prophylactic agent compared to indomethacin (41%).
  
  
  CONCLUSIONS
  NSAIDs seem to have clinically proven advantage of reducing the risk of post-ERCP pancreatitis.
authors.affiliation: Muhammad S Sajid, Amir H Khawaja, Department of General, Endoscopic and Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Foundation Trust Worthing Hospital Worthing, West Sussex BN11 2DH, United Kingdom.
authors.forename: Muhammad S
authors.initials: MS
authors.lastname: Sajid
authors.affiliation: Muhammad S Sajid, Amir H Khawaja, Department of General, Endoscopic and Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Foundation Trust Worthing Hospital Worthing, West Sussex BN11 2DH, United Kingdom.
authors.forename: Amir H
authors.initials: AH
authors.lastname: Khawaja
authors.affiliation: Muhammad S Sajid, Amir H Khawaja, Department of General, Endoscopic and Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Foundation Trust Worthing Hospital Worthing, West Sussex BN11 2DH, United Kingdom.
authors.forename: Mazin
authors.initials: M
authors.lastname: Sayegh
authors.affiliation: Muhammad S Sajid, Amir H Khawaja, Department of General, Endoscopic and Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Foundation Trust Worthing Hospital Worthing, West Sussex BN11 2DH, United Kingdom.
authors.forename: Krishna K
authors.initials: KK
authors.lastname: Singh
authors.affiliation: Muhammad S Sajid, Amir H Khawaja, Department of General, Endoscopic and Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Foundation Trust Worthing Hospital Worthing, West Sussex BN11 2DH, United Kingdom.
authors.forename: Zinu
authors.initials: Z
authors.lastname: Philipose
keywords: Diclofenac; Endoscopic retrograde cholangiopancreatography; Indomethacin; Non-steroidal drugs; Pancreatitis