Systematic review and meta-analysis: no evidence that low-dose non-steroidal anti-inflammatory drugs (NSAIDs) reduce the risk of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP)

BackgroundCurrently, many studies focus on the use of high-dose NSAIDs, showing significant effectiveness in preventing post-ERCP pancreatitis after surgery. However, some studies suggest that low-dose NSAIDs can also have certain effects. Nevertheless, after using propensity score matching to balance potential biases, the results do not seem ideal and fail to demonstrate clear effectiveness.AimThis study investigates the effectiveness of NSAIDs in preventing post-ERCP pancreatitis through a systematic review and meta-analysis of relevant literature.MethodsWe conducted a systematic search of PubMed, Embase, and Web of Science, covering literature up to September 2024. The search utilized keywords such as "ERCP," "NSAIDs," and "propensity score matching." A total of three studies employing propensity score matching were included, encompassing 857 patients-417 receiving NSAIDs before ERCP and 440 in the control group. Statistical analysis was performed using RevMan 5.3, applying a random-effects model for meta-analysis.ResultsThe meta-analysis revealed no significant difference in treatment outcomes between the NSAID and control groups, with an odds ratio (OR) of 0.82 (95% CI: 0.45-1.49, P = 0.74) and no observed heterogeneity (I-2=0%). Sensitivity analysis confirmed the stability of results, indicating minimal impact from the removal of any single study.DiscussionThese findings challenge previous assertions that NSAIDs effectively reduce post-ERCP pancreatitis incidence. The lack of consistent evidence raises concerns about the reliability of existing research. Additionally, the lower NSAID doses used in studies may contribute to the observed ineffectiveness. Future large-scale, well-designed clinical trials are essential to establish clear treatment guidelines and enhance patient outcomes.