title: Rectal NSAIDs in the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis in unselected patients: Systematic review and meta-analysis.
abstract: OBJECTIVE
  Efficacy of rectal non-steroidal anti-inflammatory drugs (NSAIDs) for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) prophylaxis in unselected patients remained controversial. The aim of the present study was to evaluate the efficacy of rectal NSAIDs in the prevention of PEP in unselected patients.
  
  
  METHODS
  An electronic literature search in the Cochrane Library, Embase, and PubMed was carried out for randomized controlled trials comparing rectal indomethacin or diclofenac with placebo in the prevention of PEP in unselected patients. Cochrane risk of bias tool was used to evaluate methodological quality. The data were carried out in forest plots using fixed-effect methods, and random-effect methods were used when heterogeneity was significant.
  
  
  RESULTS
  A total of nine trials were included in our final analysis. Rectal NSAIDs were effective to reduce the incidence of PEP in unselected patients (RR, 0.61; 95% CI, 0.46-0.79), especially for moderate-to-severe PEP (RR, 0.37; 95% CI, 0.17-0.79). Both indomethacin (RR, 0.67; 95% CI, 0.50-0.88) and diclofenac (RR, 0.29; 95% CI, 0.12-0.69) were significantly efficacious. Rectal NSAIDs given pre-ERCP showed significant efficacy (RR, 0.53; 95% CI, 0.39-0.71), whether when given within 30 min pre-ERCP (RR, 0.62; 95% CI, 0.42-0.92) or not (RR, 0.43; 95% CI, 0.28-0.67).
  
  
  CONCLUSIONS
  Rectal NSAIDs are effective in the prevention of PEP in unselected patients.
authors.affiliation: The Second Clinical Medical School, Southern Medical University, Guangzhou City, China.
authors.forename: Chongrong
authors.identifier: http://orcid.org/0000-0001-7164-3888
authors.initials: C
authors.lastname: Shen
authors.affiliation: The Second Clinical Medical School, Southern Medical University, Guangzhou City, China.
authors.forename: Yanqiang
authors.initials: Y
authors.lastname: Shi
authors.affiliation: The Second Clinical Medical School, Southern Medical University, Guangzhou City, China.
authors.forename: Tianyu
authors.initials: T
authors.lastname: Liang
authors.affiliation: Department of Gastroenterology, First People's Hospital of Foshan Affiliated to Sun Yat-sen University, Foshan City, China.
authors.forename: Peizhu
authors.initials: P
authors.lastname: Su
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*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D007213:Indomethacin
keywords: diclofenac; endoscopic retrograde cholangiopancreatography (ERCP); indomethacin; meta-analysis; pancreatitis