title: Endoscopic and pharmacological treatment for prophylaxis against postendoscopic retrograde cholangiopancreatography pancreatitis: a meta-analysis and systematic review.
abstract: OBJECTIVE
  Postendoscopic retrograde cholangiopancreatography (post-ERCP) pancreatitis (PEP) is the most common complication following ERCP. We carried out a systematic review and meta-analysis of the global literature on PEP prevention to provide clinical guidance and a framework for future research in this important field.
  
  
  METHODS
  PubMed, Embase, Science Citation Index, Ovid, and the Cochrane Controlled Trials Register were searched by two independent reviewers to identify full-length, prospective, randomized controlled trials (RCTs) published up until March 2016 investigating the use of pancreatic duct stents and pharmacological agents to prevent PEP.
  
  
  RESULTS
  Twelve RCTs comparing the risk of PEP after pancreatic duct stent placement (1369 patients) and 30 RCTs comparing pharmacological agents over placebo (10251 patients) fulfilled the inclusion criteria and were selected for final review and analysis. Meta-analysis showed that prophylactic pancreatic stents significantly decreased the odds of post-ERCP pancreatitis [odds ratio (OR), 0.28; 95% confidence interval (CI), 0.18-0.42]. Significant OR reduction of PEP was also observed in relation to rectal administration of diclofenac (OR, 0.24; 95% CI, 0.12-0.48) and rectal administration of indometacin (OR, 0.59; 95% CI, 0.44-0.79) compared with placebo. Subgroup analysis showed a significant reduction with bolus-administered somatostatin (OR, 0.23; 95% CI, 0.11-0.49). Subgroup analysis showed a significant reduction with bolus-administered somatostatin (OR, 0.23; 95% CI, 0.11-0.49).
  
  
  CONCLUSIONS
  Pancreatic stent placement, rectal diclofenac, and bolus administration of somatostatin appear to be most effective in preventing post-ERCP pancreatitis.
authors: aDepartment of Gastroenterology and Digestive Endoscopy, Academic Center 'Santa Maria della Misericordia', Udine, Italy bDepartment of Internal Medicine, Regionalspital Emmental AG, Langnau im Emmental, Switzerland cUniversity Clinical-Hospital Center 'Dr Dragisa Misovic-Dedinje' dFaculty of Medicine, University of Belgrade, Belgrade, Serbia.
authors: Salvatore F
authors: SF
authors: Vadalà di Prampero
authors: Giacomo
authors: G
authors: Faleschini
authors: Nikola
authors: N
authors: Panic
authors: Milutin
authors: M
authors: Bulajic
mesh_terms: D061605:Administration, Intravenous; D000285:Administration, Rectal; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000379:methods*; D004008:Diclofenac / Q000627:therapeutic use; D006728:Hormones / Q000627:therapeutic use*; D006801:Humans; D007213:Indomethacin / Q000627:therapeutic use; D016017:Odds Ratio; D010183:Pancreatic Ducts; D010195:Pancreatitis / Q000209:etiology / Q000517:prevention & control*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D013004:Somatostatin / Q000627:therapeutic use*; D015607:Stents
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D006728:Hormones; D004008:Diclofenac; D013004:Somatostatin; D007213:Indomethacin