Endoscopy 2018; 50(04): S25
DOI: 10.1055/s-0038-1637101
ESGE Days 2018 oral presentations
20.04.2018 – ERCP 1: cannulation and adverse effects
Georg Thieme Verlag KG Stuttgart · New York

COMPARISON OF THE EFFECTIVENESS OF RECTAL INDOMETHACIN VERSUS PROPHYLACTIC PANCREATIC STENTS FOR THE PREVENTION OF MODERATE TO SEVERE POST-ERCP PANCREATITIS – A META-ANALYSIS OF RCTS

Z Dubravcsik
1   Bács-Kiskun County Teaching Hospital, OMCH Endoscopy Unit, Kecskemét, Hungary
,
M Szalai
2   Endo-Kapszula Endoscopy Unit, Székesfehérvár, Hungary
,
L Oczella
2   Endo-Kapszula Endoscopy Unit, Székesfehérvár, Hungary
,
A Szepes
1   Bács-Kiskun County Teaching Hospital, OMCH Endoscopy Unit, Kecskemét, Hungary
,
L Madácsy
2   Endo-Kapszula Endoscopy Unit, Székesfehérvár, Hungary
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

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Aims:

Pancreatitis is one of the most frequent and potentially life-threatening complications of endoscopic retrograde cholangiopancreatography (ERCP). According to recent randomized controlled trials (RCTs) both rectal administration of indomethacin (IM) before and the placement of a prophylactic pancreatic stent (PPS) during ERCP are effective to prevent post-ERCP pancreatitis (PEP), however up till now no RCT compared the effectiveness of these methods in the prevention of moderate and severe PEP. Therefore, we aimed to provide an up-to-date meta-analysis to compare the efficacy of these prevention strategies concerning moderate and severe PEP.

Methods:

The Embase, PubMed, and Cochrane databases were searched for RCTs considering PPS placement and rectal IM administration with the subsequent incidence of PEP. The primary outcome measure was the incidence of moderate to severe PEP. 11 RCTs administered rectal IM and 5 RCTs applied PPS for the prevention of PEP, the outcome from all of these studies was incorporated into our meta-analysis.

Results:

A total of 3310 patients included in our meta-analysis; 603 patients had PPS placement, 1044 patients had a rectal administration of IM and 1663 patients formed the combined control group. In these patient groups, moderate to severe PEP developed in 7 (1,16%), 18 (1,72%) and 73 (4,39%) patients, respectively. Both PPS placement (relative risk [RR] 0.23; P < 0.0001) and rectal IM administration (relative risk [RR] 0.46; P < 0.01) was associated with a statistically significant reduction in moderate to severe PEP, respectively. The number needed to treat to prevent one episode of moderate to severe PEP was 24 in the PPS and 48 in the IM group.

Conclusions:

Our meta-analysis clearly demonstrates that PPS placement significantly reduces the risk of moderate to severe PEP, and the preventive effect of PPS is more efficient than rectal IM administration, especially for life-threatening complications.