Is rectal indomethacin effective in preventing of post-endoscopic retrograde cholangiopancreatography pancreatitis?

Döbrönte, Z; Szepes, Zoltán; Izbéki, Ferenc; Gervain, Judit; Lakatos, L.; Pécsi, G; Ihász, M; Lakner, Lilla; Toldy, Erzsébet; Czakó, László

doi:10.3748/wjg.v20.i29.10151

Cited by 60 publications

(93 citation statements)

References 27 publications

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“…The comparison remained unchanged after excluding two studies with higher rates of pancreatic duct injection and higher risk of bias ( Z = 1.58, P = 0.115) …”

Section: Resultsmentioning

confidence: 98%

“…Six studies (2473 participants) were included in the systematic review and meta‐analysis . Study characteristics are summarized in Table .…”

Section: Resultsmentioning

confidence: 99%

“…One trial excluded chronic pancreatitis . Two trials excluded previous sphincterotomy . One trial excluded patients with cannulation of the minor papilla, previous severe PEP, or papillectomy …”

Section: Resultsmentioning

confidence: 99%

“…To our knowledge, the present study is the first meta‐analysis of available randomized controlled trials on indomethacin prophylaxis for the prevention of PEP in general patients, which enrolled consecutive patients only, compared with high‐risk patients in other studies. Additionally, three most recent RCT that had never been analyzed were included in the present study …”

Section: Discussionmentioning

confidence: 99%

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Prophylactic rectal indomethacin may be ineffective for preventing post‐endoscopic retrograde cholangiopancreatography pancreatitis in general patients: A meta‐analysis

Feng

Navaneethan

Zhu

et al. 2017

Digestive Endoscopy

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“…The comparison remained unchanged after excluding two studies with higher rates of pancreatic duct injection and higher risk of bias ( Z = 1.58, P = 0.115) …”

Section: Resultsmentioning

confidence: 98%

“…Six studies (2473 participants) were included in the systematic review and meta‐analysis . Study characteristics are summarized in Table .…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Prophylactic rectal indomethacin may be ineffective for preventing post‐endoscopic retrograde cholangiopancreatography pancreatitis in general patients: A meta‐analysis

Feng

Navaneethan

Zhu

et al. 2017

Digestive Endoscopy

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show abstract

“…Nor were indomethacin suppositories used as a preventive measure due to their controversial role in preventing post-ERCP pancreatitis [Amara et al 2014;Döbrönte et al 2014].…”

Section: Resultsmentioning

confidence: 99%

Early ‘shallow’ needle-knife papillotomy and guidewire cannulation: an effective and safe approach to difficult papilla

Fiocca

Fanello

Cereatti

et al. 2015

Therap Adv Gastroenterol

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Rectal indomethacin and diclofenac are equally efficient in preventing pancreatitis following endoscopic retrograde cholangiopancreatography in average‐risk patients

Shen

et al. 2021

JGH Open

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Rectal indomethacin and diclofenac are promising drugs for prevention of post‐endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). However, their prophylactic effect on PEP in average‐risk patients remains controversial. We performed a systematic review and meta‐analysis to assess the efficacy and safety of rectal indomethacin and diclofenac in average‐risk patients, and to indirectly compare the prophylactic effect of the two drugs. A comprehensive search of the PubMed, EMBASE, and Cochrane Library databases was performed to identify randomized controlled trials (RCTs) on rectal indomethacin or diclofenac for prophylaxis against PEP. Fixed‐ and random‐effects models weighted by the Mantel–Haenszel method were used for direct comparisons. The adjusted indirect treatment comparison method was used to indirectly compare the efficacy of indomethacin and diclofenac. A total of 10 RCTs, including 2928 patients, met our inclusion criteria. No significant publication bias was identified. Pooled estimates showed that rectal indomethacin and diclofenac were associated with a significant reduction in the overall risk of PEP compared with control intervention [relative risk (RR) = 0.62; 95% confidence interval (CI): 0.46–0.83] in average‐risk patients. Subgroup analyses showed that both rectal indomethacin (RR = 0.67; 95% CI: 0.49–0.94) and diclofenac (RR = 0.42; 95% CI: 0.23–0.75) were effective in the prevention of PEP. Indirect comparison showed no significant difference between the effectiveness of the two drugs in the prevention of PEP (RR = 1.607; 95% CI: 0.824–3.136). The updated meta‐analysis suggests that both drugs provide equivalent protection against PEP in average‐risk patients.

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Is rectal indomethacin effective in preventing of post-endoscopic retrograde cholangiopancreatography pancreatitis?

Abstract: 100 mg rectal indomethacin administered before ERCP did not prove effective in preventing post-ERCP pancreatitis.

Cited by 60 publications

References 27 publications

Prophylactic rectal indomethacin may be ineffective for preventing post‐endoscopic retrograde cholangiopancreatography pancreatitis in general patients: A meta‐analysis

Prophylactic rectal indomethacin may be ineffective for preventing post‐endoscopic retrograde cholangiopancreatography pancreatitis in general patients: A meta‐analysis

Early ‘shallow’ needle-knife papillotomy and guidewire cannulation: an effective and safe approach to difficult papilla

Rectal indomethacin and diclofenac are equally efficient in preventing pancreatitis following endoscopic retrograde cholangiopancreatography in average‐risk patients

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