Rectal indomethacin with topical epinephrine versus indomethacin alone for preventing Post-ERCP pancreatitis - A systematic review and meta-analysis.
Administration, Rectal
Anti-Inflammatory Agents, Non-Steroidal
/ administration & dosage
Cholangiopancreatography, Endoscopic Retrograde
/ adverse effects
Epinephrine
/ administration & dosage
Humans
Indomethacin
/ administration & dosage
Pancreatitis
/ drug therapy
Vasoconstrictor Agents
/ administration & dosage
ERCP
Epinephrine
Indomethacin
Pancreatitis
Post-ERCP pancreatitis
Journal
Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.]
ISSN: 1424-3911
Titre abrégé: Pancreatology
Pays: Switzerland
ID NLM: 100966936
Informations de publication
Date de publication:
Apr 2020
Apr 2020
Historique:
received:
01
12
2019
revised:
04
02
2020
accepted:
08
02
2020
pubmed:
29
2
2020
medline:
27
2
2021
entrez:
29
2
2020
Statut:
ppublish
Résumé
Recent studies have compared the utility of rectal indomethacin with topical epinephrine (IE) sprayed on duodenal papilla and rectal indomethacin alone (IS) to prevent post-ERCP pancreatitis (PEP) with conflicting results. We performed a systematic review and meta-analysis to evaluate the benefit of using the combination prophylaxis as oppose to rectal indomethacin alone. The following database were searched for our systematic review: PubMed∖Medline, Embase, Cochrane, and Web of Science. We included both randomized controlled trials (RCTs) and cohort studies. Primary outcome was incidence of PEP and secondary outcomes were adverse events and mortality. A total of 3 studies (all RCTs) with 2244 patients (1132 in IS and 1112 in IE group) were included. The IE group did not demonstrate any significant benefit over IS group in preventing PEP (RR: 1.15, 95% CI 0.62-2.2), mortality (RR: 0.85, 95% CI 0.22-3.24) or overall adverse events (RR: 1.3, 95% CI 0.93-1.7). The combination of rectal indomethacin and topical epinephrine failed to demonstrate any benefit over indomethacin alone in preventing PEP, decreasing mortality and overall adverse events.
Sections du résumé
BACKGROUND
BACKGROUND
Recent studies have compared the utility of rectal indomethacin with topical epinephrine (IE) sprayed on duodenal papilla and rectal indomethacin alone (IS) to prevent post-ERCP pancreatitis (PEP) with conflicting results. We performed a systematic review and meta-analysis to evaluate the benefit of using the combination prophylaxis as oppose to rectal indomethacin alone.
METHODS
METHODS
The following database were searched for our systematic review: PubMed∖Medline, Embase, Cochrane, and Web of Science. We included both randomized controlled trials (RCTs) and cohort studies. Primary outcome was incidence of PEP and secondary outcomes were adverse events and mortality.
RESULTS
RESULTS
A total of 3 studies (all RCTs) with 2244 patients (1132 in IS and 1112 in IE group) were included. The IE group did not demonstrate any significant benefit over IS group in preventing PEP (RR: 1.15, 95% CI 0.62-2.2), mortality (RR: 0.85, 95% CI 0.22-3.24) or overall adverse events (RR: 1.3, 95% CI 0.93-1.7).
CONCLUSION
CONCLUSIONS
The combination of rectal indomethacin and topical epinephrine failed to demonstrate any benefit over indomethacin alone in preventing PEP, decreasing mortality and overall adverse events.
Identifiants
pubmed: 32107191
pii: S1424-3903(20)30039-9
doi: 10.1016/j.pan.2020.02.003
pii:
doi:
Substances chimiques
Anti-Inflammatory Agents, Non-Steroidal
0
Vasoconstrictor Agents
0
Indomethacin
XXE1CET956
Epinephrine
YKH834O4BH
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
356-361Informations de copyright
Copyright © 2020 IAP and EPC. Published by Elsevier B.V. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of competing interest The authors declare no conflict of interest. No human subjects/animals were involved in this systematic review and meta-analysis. No funding was received for the preparation of this manuscript.