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Nonsteroidal anti-inflammatory drug effectivity in preventing postendoscopic retrograde cholangiopancreatography pancreatitis: A systematic review and meta-analysis

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World Journal of Gastrointestinal Endoscopy 2020年第11期12卷 469-487页

作者： Juan Pablo Román Serrano joséJukemura Samuel Galante Romanini Paúl Fernando Guamán Aguilar Juliana Silveira Lima de Castro Isabela Trindade Torres joséandres sanchez pulla Otavio Micelli Neto Eloy Taglieri joséCelso Ardengh Department of Gastroenterology University of Sao PauloSão Paulo 05403-000São PauloBrazil Department of Gastrointestinal Endoscopy Service Hospital 9 de JulhoSão Paulo 01409002São PauloBrazil Department of Gastroinestinal Catholic University of CuencaCuenca 010101Ecuador Department of General Surgery Servidor Municipal HospitalSão Paulo 01532-001Brazil

BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is the primary therapeutic procedure for the treatment of diseases affecting the biliary tree and pancreatic *** the therapeutic success rate of ERCP is high,the procedure can cause complications,such as acute pancreatitis[post-ERCP pancreatitis(PEP)],bleeding and *** To assess the efficacy of non-steroidal anti-inflammatory drugs(NSAIDs)in preventing PEP during *** Databases such as MEDLINE,EMBASE and Cochrane Central Library were *** randomized controlled trials(RCTs)comparing the efficacy of NSAIDs and placebo for the prevention of PEP were *** evaluated included the incidence of PEP,severity of pancreatitis,route of administration,types,dose,and timing of administration of *** Twenty-six RCTs were considered eligible with a total of 8143 patients ***,4020 patients used NSAIDs before ERCP and 4123 did not use NSAIDs(control group).Ultimately,298 cases of post-ERCP acute pancreatitis were diagnosed in the NSAID group and 484 cases in the placebo *** risk of PEP was lower in the NSAID group risk difference(RD):-0.04;95%confidence interval(CI):-0.07 to-0.03;number needed to treat(NNT),25;P<*** use effectively prevented mild pancreatitis compared to placebo use(2.5%vs 4.1%;95%CI:-0.05 to-0.01;NNT,33;P<0.05),but information on moderate PEP and severe PEP could not be fully *** rectal administration reduced the incidence of PEP with RD:-0.06;95%CI:-0.08 to-0.04;NNT,17;P<0.05).Furthermore,only the use of diclofenac or indomethacin was effective in preventing PEP,at a dose of 100 mg,which must be administered before performing *** Rectal administration of diclofenac and indomethacin significantly reduced the risk of developing mild *** RCTs are needed to compare the efficacy between NSAID routes of administration in preventing PEP.

关键词： Pancreatitis Endoscopic retrograde cholangiopancreatography Diclofenac Indomethacin Rectal

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