November 12, 2014
Notes: Acevedo-Piedra, Nelly G
Clin Gastroenterol Hepatol. 2014 Feb;12(2):311-6. doi: 10.1016/j.cgh.2013.07.042. Epub 2013 Aug 16.
Author Address: Unidad de Patologia Pancreatica, Hospital General Universitario de Alicante, Alicante, Spain.
Servicio de Radiologia, Hospital General Universitario de Alicante, Alicante, Spain.
Servicio de Medicina Preventiva, Hospital General Universitario de Alicante, Alicante, Spain.
Unidad de Patologia Pancreatica, Hospital General Universitario de Alicante, Alicante, Spain. Electronic address: firstname.lastname@example.org.
Reference Type: Journal Article
Record Number: 4865Author: Akshintala, V. S., Hutfless, S. M., Colantuoni, E., Kim, K. J., Khashab, M. A., Li, T., Elmunzer, B. J., Puhan, M. A., Sinha, A., Kamal, A., Lennon, A. M., Okolo, P. I., Palakurthy, M. K., Kalloo, A. N. and Singh, V. K.
Title: Systematic review with network meta-analysis: pharmacological prophylaxis against post-ERCP pancreatitis
Journal: Aliment Pharmacol Ther
Short Title: Systematic review with network meta-analysis: pharmacological prophylaxis against post-ERCP pancreatitis
Alternate Journal: Alimentary pharmacology & therapeutics
ISSN: 1365-2036 (Electronic)
Accession Number: 24138390
Keywords: Administration, Rectal
Anti-Inflammatory Agents, Non-Steroidal/administration & dosage/*therapeutic use
Cholangiopancreatography, Endoscopic Retrograde/*adverse effects
Drug Therapy, Combination
Epinephrine/administration & dosage/*therapeutic use
Pancreatitis/etiology/*prevention & control
Randomized Controlled Trials as Topic
Abstract: BACKGROUND: The efficacy of many pharmacological agents for preventing post-ERCP pancreatitis (PEP) has been evaluated in randomised controlled trials (RCTs), but it is unclear which agent(s) should be used in clinical practice. Network meta-analyses of RCTs are used to simultaneously compare several agents to determine their relative efficacy and identify priority agents for comparison in future RCTs. AIM: To evaluate pharmacological agents for the prevention of PEP by conducting a network meta-analysis of RCTs. METHODS: We searched MEDLINE, EMBASE and Cochrane Library databases for RCTs that evaluated the efficacy of agents for preventing PEP. RCTs were simultaneously analysed using random-effects network meta-analysis under the Bayesian framework to identify the best agents. The efficacy of agents was ordered according to the probability of being ranked as any of the top three best performing agents. RESULTS: The network meta-analysis included 99 RCTs evaluating 16 agents in 25 313 patients. Topical epinephrine (adrenaline) was the most efficacious agent with 85.9% probability of ranking among the top three agents, followed by nafamostat (51.4%), antibiotics (44.5%) and NSAIDs (42.8%). However, in a sensitivity analysis including only rectal NSAIDs, NSAIDs moved from fourth rank to second (58.1%). Patients receiving topical epinephrine, compared with placebo, had a 75% reduced risk of PEP (OR 0.25, 95% probability interval 0.06-0.66). CONCLUSIONS: Topical epinephrine and rectal NSAIDs are the most efficacious agents for preventing post-ERCP pancreatitis, based on existing RCTs. Combinations of these agents, which act on different steps in the pathogenesis of post-ERCP pancreatitis, should be evaluated in future trials.