title: Prophylactic rectal indomethacin may be ineffective for preventing post-endoscopic retrograde cholangiopancreatography pancreatitis in general patients: A meta-analysis.
abstract: OBJECTIVE
  Efficacy of prophylactic indomethacin for prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) in general patients remains controversial. To address this, we conducted a meta-analysis of clinical trials specifically on rectal indomethacin in prevention of PEP in consecutive patients undergoing ERCP.
  
  
  METHODS
  We searched MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials databases to identify randomized, double-blind, controlled clinical trials on rectal indomethacin in the prevention of PEP in consecutive patients undergoing ERCP. Primary outcome was the overall rate of PEP. Secondary outcomes were the overall rates of moderate to severe PEP and mild PEP.
  
  
  RESULTS
  Six studies, with a total of 2473 patients, were included. Overall rate of PEP was 7% (95% CI, 6-9%). No statistical difference was observed in overall rates of PEP (OR, 0.67; 95% CI, 0.46-1.00, P = 0.050) and, additionally, rates of moderate to severe (OR, 0.66; 95% CI, 0.28-1.56, P = 0.345) or mild (OR, 0.71; 95% CI, 0.45-1.10, P = 0.127) PEP between indomethacin and placebo.
  
  
  CONCLUSIONS
  In a contemporary meta-analysis of available randomized controlled trials of consecutive patients undergoing ERCP, rectal indomethacin did not show significant prevention effect of post-ERCP pancreatitis.
authors.affiliation: Center for Interventional Endoscopy, Florida Hospital, Orlando, USA.|Department of Gastroenterology, Peking Union Medical College Hospital, Beijing, China.
authors.forename: Yunlu
authors.identifier: http://orcid.org/0000-0002-2761-100X
authors.initials: Y
authors.lastname: Feng
authors.affiliation: Center for Interventional Endoscopy, Florida Hospital, Orlando, USA.
authors.forename: Udayakumar
authors.initials: U
authors.lastname: Navaneethan
authors.affiliation: Center for Interventional Endoscopy, Florida Hospital, Orlando, USA.
authors.forename: Xiang
authors.initials: X
authors.lastname: Zhu
authors.affiliation: Center for Interventional Endoscopy, Florida Hospital, Orlando, USA.
authors.forename: Shyam
authors.initials: S
authors.lastname: Varadarajulu
authors.affiliation: Center for Interventional Endoscopy, Florida Hospital, Orlando, USA.|Hospital Sao Lucas, Rio de Janeiro, Brazil.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Schwartz
authors.affiliation: Center for Interventional Endoscopy, Florida Hospital, Orlando, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Hawes
authors.affiliation: Center for Interventional Endoscopy, Florida Hospital, Orlando, USA.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Hasan
authors.affiliation: Department of Gastroenterology, Peking Union Medical College Hospital, Beijing, China.
authors.forename: Aiming
authors.initials: A
authors.lastname: Yang
mesh_terms: D000285:Administration, Rectal; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D006801:Humans; D007213:Indomethacin / Q000008:administration & dosage*; D010195:Pancreatitis / Q000209:etiology / Q000517:prevention & control*; D012307:Risk Factors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D007213:Indomethacin
keywords: endoscopic retrograde cholangiopancreatography (ERCP); indomethacin; meta-analysis; pancreatitis; prevention