Systematic review and meta-analysis on the prophylactic role of non-steroidal anti-inflammatory drugs to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis

Table 1 Characteristics of included trials

Ref.	Year	Country	Time of administration	Route	Dose	Type of NSAIDs used
Cheon et al[22]	2007	United States	Before ERCP	Oral	50 mg	Diclofenac
Döbrönte et al[23]	2012	Hungary	Before ERCP	Rectal	100 mg	Indomethacin
Döbrönte et al[24]	2014	Hungary	Before ERCP	Rectal	100 mg	Indomethacin
Elmunzer et al[25]	2012	United States	After ERCP	Rectal	100 mg	Indomethacin
Khoshbaten et al[26]	2008	Iran	After ERCP	Rectal	100 mg	Diclofenac
Montaño Loza et al[27]	2006	Mexico	Before ERCP	Rectal	100 mg	Indomethacin
Montaño Loza et al[28]	2007	Mexico	Before ERCP	Rectal	100 mg	Indomethacin
Murray et al[29]	2003	United Kingdom	After ERCP	Rectal	100 mg	Diclofenac
Otsuka et al[30]	2012	Japan	Before ERCP	Rectal	50 mg	Diclofenac
Park et al[31]	2014	United States South Korea	After ERCP	Intramuscular	90 mg	Diclofenac
Senol et al[32]	2009	Turkey	After ERCP	Intravenous infusion	75 mg	Diclofenac
Sotoudehmanesh et al[33]	2007	Iran	Before ERCP	Rectal	100 mg	Indomethacin
Zhao et al[34]	2014	China	After ERCP	Intramuscular	75 mg	Diclofenac

NSAIDs: Non-steroidal anti-inflammatory drugs; ERCP: Endoscopic retrograde cholangio-pancreaticography.

Table 2 Summary and strength of the evidence from trials analysed on GradePro^®

Author(s): Sajid et al
Date: 20/10/2015
Question: NSAID’s are an effective modality to reduce the incidence of post-ERCP pancreatitis?
Settings: All patients undergoing booth elective or emergency ERCP in endoscopy department for any indication by an experienced gastroenterologist/endoscopists
Bibliography: Adapted from the Cochrane Database of Systematic Reviews [2015, Issue (Is)]
Quality assessment							No. of patients		Effect		Quality	Importance
No. of studies	Design	Risk of bias	Inconsistency	Indirectness	Imprecision	Other considerations	NSAID's vs placebo	Control	Relative(95%CI)	Absolute
Incidence of overall pancreatitis (follow-up mean 3 mo; assessed with: Odds ratio)
14	Randomised trials	Serious	No serious inconsistency	No serious indirectness	No serious imprecision	Strong association	138/1900	248/1878	OR 0.49 (0.36 to 0.67)	63 fewer per 1000 (from 40 fewer to 80 fewer)	High	Critical
							(7.3%)	(13.2%)
								15.7%		73 fewer per 1000 (from 46 fewer to 94 fewer)

NSAIDs: Non-steroidal anti-inflammatory drugs; ERCP: Endoscopic retrograde cholangio-pancreaticography.

Table 3 Reported quality variables in included studies

Ref.	Randomization	Power calculations	ITT	Blinding	Concealment
Cheon et al[22]	Yes	Yes	Yes	Yes	Yes
Döbrönte et al[23]	Yes	Yes	No	Yes	Yes
Döbrönte et al[24]	Yes	Yes	No	Yes	Yes
Elmunzer et al[25]	Yes	Yes	Yes	Yes	Yes
Khoshbaten et al[26]	Yes	Yes	No	Yes	Yes
Montaño Loza et al[27]	Yes	Yes	No	Yes	Yes
Montaño Loza et al[28]	Yes	Yes	No	Yes	Not reported
Murray et al[29]	Yes	Yes	No	Yes	Yes
Otsuka et al[30]	Yes	Yes	No	Yes	Yes
Park et al[31]	Yes	Yes	No	Yes	Yes
Senol et al[32]	Yes	Yes	No	Not reported	Not reported
Sotoudehmanesh et al[33]	Yes	Yes	No	Yes	Yes
Zhao et al[34]	Yes	Yes	No	No	Not reported