Non-steroidal anti-inflammatory drugs, intravenous fluids, pancreatic stents, or their combinations for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: a systematic review and network meta-analysis

医学 内镜逆行胰胆管造影术 胰腺炎 荟萃分析 内科学 随机对照试验 优势比 急性胰腺炎 安慰剂 胃肠病学 病理 替代医学
作者
Venkata S. Akshintala,Christina J. Sperna Weiland,Furqan A. Bhullar,Ayesha Kamal,Kavin Kanthasamy,Albert Kuo,Cristian Tomasetti,Merve Gürakar,Joost P.H. Drenth,Dhiraj Yadav,B. Joseph Elmunzer,D. Nageshwar Reddy,Mahesh Kumar Goenka,Rakesh Kochhar,Anthony N. Kalloo,Mouen A. Khashab,Erwin J. M. van Geenen,Vikesh K. Singh
出处
期刊:The Lancet Gastroenterology & Hepatology [Elsevier]
卷期号:6 (9): 733-742 被引量:63
标识
DOI:10.1016/s2468-1253(21)00170-9
摘要

Non-steroidal anti-inflammatory drugs (NSAIDs), intravenous fluid, pancreatic stents, or combinations of these have been evaluated in randomised controlled trials (RCTs) for the prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis, but the comparative efficacy of these treatments remains unclear. Our aim was to do an exploratory network meta-analysis of previous RCTs to systematically compare the direct and indirect evidence and rank NSAIDs, intravenous fluids, pancreatic stents, or combinations of these to determine the most efficacious method of prophylaxis for post-ERCP pancreatitis.We searched PubMed, Embase, and the Cochrane Central Register from inception to Nov 15, 2020, for full-text RCTs that evaluated the efficacy of NSAIDs, pancreatic stents, intravenous fluids, or combinations of these for post-ERCP pancreatitis prevention in adult (aged ≥18 years) patients undergoing ERCP. Summary data from intention-to-treat analyses were extracted from published reports. We analysed incidence of post-ERCP pancreatitis across studies using network meta-analysis under the frequentist framework, obtaining pairwise odds ratios (ORs) and 95% CIs. We used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system for the confidence rating. This study is registered with PROSPERO, CRD42020172606.We identified 1503 studies, of which 55 RCTs evaluating 20 interventions in 17 062 patients were included in the network meta-analysis. The mean incidence of post-ERCP pancreatitis in the placebo or active control group was 12·2% (95% CI 11·4-13·0). Normal saline plus rectal indometacin (OR 0·02, 95% CI 0·00-0·40), intramuscular diclofenac 75 mg (0·24, 0·09-0·69), intravenous high-volume Ringer's lactate plus rectal diclofenac 100 mg (0·30, 0·16-0·55), intravenous high-volume Ringer's lactate (0·31, 0·12-0·78), 5-7 Fr pancreatic stents (0·35, 0·26-0·48), rectal diclofenac 100 mg (0·36, 0·25-0·52), 3 Fr pancreatic stents (0·47, 0·26-0·87), and rectal indometacin 100 mg (0·60, 0·50-0·73) were all more efficacious than placebo for preventing post-ERCP pancreatitis in pairwise comparisons. 5-7 Fr pancreatic stents (0·59, 0·41-0·84), intravenous high-volume Ringer's lactate plus rectal diclofenac 100 mg (0·49, 0·26-0·94), intravenous standard-volume normal saline plus rectal indometacin 100 mg (0·04, 0·00-0·66), and rectal diclofenac 100 mg (0·59, 0·40-0·89) were more efficacious than rectal indometacin 100 mg. The GRADE confidence rating was low to moderate for 98·3% of the pairwise comparisons.This systematic review and network meta-analysis summarises the available literature on NSAIDs, pancreatic stents, intravenous fluids, or combinations of these for prophylaxis of post-ERCP pancreatitis. Rectal diclofenac 100 mg is the best performing rectal NSAID in this network meta-analysis. Combinations of prophylaxis might be more effective, but there is little evidence. These findings help to establish prophylaxis of post-ERCP pancreatitis for future research and practice, and could reduce costs and increase adoption of prophylaxis.None.
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
PDF的下载单位、IP信息已删除 (2025-6-4)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
闾丘山菡发布了新的文献求助10
刚刚
量子星尘发布了新的文献求助10
刚刚
Gxlm完成签到,获得积分10
1秒前
1秒前
1秒前
2秒前
humorlife完成签到,获得积分10
2秒前
十八发布了新的文献求助10
3秒前
Hello应助xiongmao采纳,获得10
3秒前
zl完成签到,获得积分10
4秒前
4秒前
qww发布了新的文献求助50
4秒前
4秒前
5秒前
助兴者发布了新的文献求助10
6秒前
酷波er应助科研通管家采纳,获得10
6秒前
Akim应助科研通管家采纳,获得10
6秒前
乐乐应助科研通管家采纳,获得10
6秒前
星辰大海应助科研通管家采纳,获得10
6秒前
CipherSage应助科研通管家采纳,获得10
6秒前
科研通AI6应助科研通管家采纳,获得10
7秒前
李健应助科研通管家采纳,获得10
7秒前
脑洞疼应助科研通管家采纳,获得30
7秒前
7秒前
共享精神应助科研通管家采纳,获得10
7秒前
dsfsd完成签到,获得积分10
7秒前
科研通AI6应助科研通管家采纳,获得10
7秒前
小c应助科研通管家采纳,获得10
7秒前
大模型应助科研通管家采纳,获得10
7秒前
whatever应助科研通管家采纳,获得10
7秒前
风中冷风完成签到,获得积分10
7秒前
852应助科研通管家采纳,获得10
7秒前
科研通AI5应助科研通管家采纳,获得10
8秒前
汉堡包应助科研通管家采纳,获得10
8秒前
whatever应助科研通管家采纳,获得20
8秒前
烟花应助科研通管家采纳,获得10
8秒前
共享精神应助科研通管家采纳,获得10
8秒前
华仔应助风飞采纳,获得10
8秒前
英姑应助Macong_44713采纳,获得10
8秒前
华仔应助hh采纳,获得10
8秒前
高分求助中
(应助此贴封号)【重要!!请各用户(尤其是新用户)详细阅读】【科研通的精品贴汇总】 10000
二维材料在应力作用下的力学行为和层间耦合特性研究 600
Food Microbiology - An Introduction (5th Edition) 500
苯丙氨酸解氨酶的祖先序列重建及其催化性能 500
Schifanoia : notizie dell'istituto di studi rinascimentali di Ferrara : 66/67, 1/2, 2024 470
Laboratory Animal Technician TRAINING MANUAL WORKBOOK 2012 edtion 400
Progress and Regression 400
热门求助领域 (近24小时)
化学 医学 生物 材料科学 工程类 有机化学 内科学 生物化学 物理 计算机科学 纳米技术 遗传学 基因 复合材料 化学工程 物理化学 病理 催化作用 免疫学 量子力学
热门帖子
关注 科研通微信公众号,转发送积分 4846160
求助须知:如何正确求助?哪些是违规求助? 4146155
关于积分的说明 12840321
捐赠科研通 3892985
什么是DOI,文献DOI怎么找? 2139834
邀请新用户注册赠送积分活动 1159815
关于科研通互助平台的介绍 1060220