TY - JOUR
T1 - NSAIDs do not reduce severity among post-ERCP pancreatitis patients
AU - El Kurdi, Bara
AU - Imam, Zaid
AU - Abonofal, Abdulrahman
AU - Babar, Sumbal
AU - Shah, Pir
AU - Pannala, Rahul
AU - Papachristou, Georgios
AU - Echavarria, Juan
AU - Pisipati, Sailaja
AU - Jahangir, Sarah
AU - Rajalingamgari, Prasad
AU - Chang, Yu Hui H.
AU - Singh, Vijay P.
N1 - Publisher Copyright:
© 2023 IAP and EPC
PY - 2024/2
Y1 - 2024/2
N2 - Objective: Non-steroidal anti-inflammatory drugs (NSAIDs) are the most studied chemoprophylaxis for post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). While previous systematic reviews have shown NSAIDs reduce PEP, their impact on moderate to severe PEP (MSPEP) is unclear. We conducted a systematic review and meta-analysis to understand the impact of NSAIDs on MSPEP among patients who developed PEP. We later surveyed physicians’ understanding of that impact. Design: A systematic search for randomized trials using NSAIDs for PEP prevention was conducted. Pooled-prevalence and Odds-ratio of PEP, MSPEP were compared between treated vs. control groups. Analysis was performed using R software. Random-effects model was used for all variables. Physicians were surveyed via email before and after reviewing our results. Results: 7688 patients in 25 trials were included. PEP was significantly reduced to 0.598 (95%CI, 0.47–0.76) in the NSAIDs group. Overall burden of MSPEP was reduced among all patients undergoing ERCP: OR 0.59 (95%CI, 0.42–0.83). However, NSAIDs didn't affect the proportion of MSPEP among those who developed PEP (p = 0.658). Rectal Indomethacin and diclofenac reduced PEP but not MSPEP. Efficacy didn't vary by risk, timing of administration, or bias-risk. Survey revealed a change in the impression of the effect of NSAIDs on MSPEP after reviewing our results. Conclusions: Rectal diclofenac or indomethacin before or after ERCP reduce the overall burden of MSPEP by reducing the pool of PEP from which it can arise. However, the proportion of MSPEP among patients who developed PEP is unaffected. Therefore, NSAIDs prevent initiation of PEP, but do not affect severity among those that develop PEP. Alternative modalities are needed to reduce MSPEP among patients who develop PEP.
AB - Objective: Non-steroidal anti-inflammatory drugs (NSAIDs) are the most studied chemoprophylaxis for post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). While previous systematic reviews have shown NSAIDs reduce PEP, their impact on moderate to severe PEP (MSPEP) is unclear. We conducted a systematic review and meta-analysis to understand the impact of NSAIDs on MSPEP among patients who developed PEP. We later surveyed physicians’ understanding of that impact. Design: A systematic search for randomized trials using NSAIDs for PEP prevention was conducted. Pooled-prevalence and Odds-ratio of PEP, MSPEP were compared between treated vs. control groups. Analysis was performed using R software. Random-effects model was used for all variables. Physicians were surveyed via email before and after reviewing our results. Results: 7688 patients in 25 trials were included. PEP was significantly reduced to 0.598 (95%CI, 0.47–0.76) in the NSAIDs group. Overall burden of MSPEP was reduced among all patients undergoing ERCP: OR 0.59 (95%CI, 0.42–0.83). However, NSAIDs didn't affect the proportion of MSPEP among those who developed PEP (p = 0.658). Rectal Indomethacin and diclofenac reduced PEP but not MSPEP. Efficacy didn't vary by risk, timing of administration, or bias-risk. Survey revealed a change in the impression of the effect of NSAIDs on MSPEP after reviewing our results. Conclusions: Rectal diclofenac or indomethacin before or after ERCP reduce the overall burden of MSPEP by reducing the pool of PEP from which it can arise. However, the proportion of MSPEP among patients who developed PEP is unaffected. Therefore, NSAIDs prevent initiation of PEP, but do not affect severity among those that develop PEP. Alternative modalities are needed to reduce MSPEP among patients who develop PEP.
UR - http://www.scopus.com/inward/record.url?scp=85176915719&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85176915719&partnerID=8YFLogxK
U2 - 10.1016/j.pan.2023.11.003
DO - 10.1016/j.pan.2023.11.003
M3 - Article
C2 - 37981523
AN - SCOPUS:85176915719
SN - 1424-3903
VL - 24
SP - 14
EP - 23
JO - Pancreatology
JF - Pancreatology
IS - 1
ER -