Nonsteroidal anti-inflammatory drugs for prevention of post-ERCP pancreatitis: a meta-analysis

Background: The use of nonsteroidal anti-inflammatory drugs (NSAIDs) in the prevention of post-ERCP pancreatitis (PEP) is still controversial. Objective: We performed a meta-analysis to evaluate the efficacy and safety of NSAIDs for PEP prophylaxis. Design: We systematically searched PubMed, EMBASE, Web of Science, and the Cochrane Library for relevant studies published updated to June 2012. Setting: Meta-analysis. Patients: Patients undergoing ERCP. Interventions: NSAIDs use for the prevention of PEP. Main Outcome Measurements: Overall incidence of PEP, incidence of moderate to severe PEP, and adverse events. Results: Ten RCTs involving 2269 patients were included. Meta-analysis showed that NSAID use decreased the overall incidence of PEP (risk ratio [RR], 0.57; 95% CI, 0.38-0.86; P = .007). The absolute risk reduction was 5.9%. The number needed to treat was 17. Heterogeneity among the studies was substantial. However, after removing the main source of heterogeneity, the prophylactic efficacy was similar (RR, 0.53; 95% CI, 0.41-0.68; P < .001). NSAID use also decreased the incidence of moderate to severe PEP (RR 0.46; 95% CI, 0.28-0.75; P = .002). The absolute risk reduction was 3.0%. The number needed to treat was 34. No differences of the adverse events attributable to NSAIDs were observed. Limitations: Inclusion of low-quality studies, different type and route of administration of the NSAIDs, study heterogeneity, inconsistent use of pancreatic stenting. Conclusions: Prophylactic use of NSAIDs reduces the incidence and severity of PEP. (Gastrointest Endosc 2012;76:1152-9.)