Meta-Analysis
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 6, 2022; 10(22): 7859-7871
Published online Aug 6, 2022. doi: 10.12998/wjcc.v10.i22.7859
Rectal nonsteroidal anti-inflammatory drugs, glyceryl trinitrate, or combinations for prophylaxis of post-endoscopic retrograde cholangiopancreatography pancreatitis: A network meta-analysis
Qing-Qing Shi, Guo-Xiu Huang, Wei Li, Jian-Rong Yang, Xiao-Yi Ning
Qing-Qing Shi, Guo-Xiu Huang, Wei Li, Department of Health Management Center, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Jian-Rong Yang, Department of Hepatobiliary, Pancreas and Spleen Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Xiao-Yi Ning, Department of Hematology, The Frist People’s Hospital of Nanning, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Author contributions: Yang JR and Li W designed the study; Li W and Huang GX carried out critical appraisal of the included studies; Shi QQ and Ning XY performed the literature search, extracted the data; Shi QQ wrote the manuscript; Yang JR and Huang GX helped to revise the manuscript; all authors critically reviewed the manuscript and approved this study to be published.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jian-Rong Yang, MD, MMed, Chief Physician, Department of Hepatobiliary, Pancreas and Spleen Surgery, the People's Hospital of Guangxi Zhuang Autonomous Region, No.6 Taoyuan Road, Qingxiu District, Nanning City 530021, Guangxi Zhuang Autonomous Region, China. 1637340358@qq.com
Received: November 10, 2021
Peer-review started: November 10, 2021
First decision: December 3, 2021
Revised: December 4, 2021
Accepted: July 5, 2021
Article in press: July 5, 2022
Published online: August 6, 2022
Processing time: 253 Days and 19.2 Hours
Abstract
BACKGROUND

Acute pancreatitis is the most common and severe complication of endoscopic retrograde cholangiopancreatography (ERCP). Recent evidence suggests that combinations based on rectal nonsteroidal anti-inflammatory drugs (NSAIDs) are more beneficial in preventing post-ERCP pancreatitis (PEP). Randomized controlled trials (RCTs) have also demonstrated the efficacy of glyceryl trinitrate (GTN). We conducted a network meta-analysis to compare NSAIDs and GTN for prevention of PEP and to determine whether they are better in combination.

AIM

To compare NSAIDs and GTN for prevention of PEP and to determine whether they are better in combination.

METHODS

A systematic search was done for full-text RCTs of PEP in PubMed, Embase, Science Citation Index, and the Cochrane Controlled Trials database. Inclusion and exclusion criteria were used to screen for eligible RCTs. The major data were extracted by two independent reviewers. The frequentist model was used to conduct this network meta-analysis and obtain the pairwise OR and 95%CI. The data were then extracted and assessed on the basis of the Reference Citation Analysis (https://www.referencecitationanalysis.com/).

RESULTS

Twenty-four eligible RCTs were selected, evaluating seven preventive strategies in 9416 patients. Rectal indomethacin 100 mg plus sublingual GTN (OR: 0.21, 95%CI: 0.09–0.50), rectal diclofenac 100 mg (0.34, 0.18–0.65), sublingual GTN (0.34, 0.12–0.97), and rectal indomethacin 100 mg (0.49, 0.33–0.73) were all more efficacious than placebo in preventing PEP. The combination of rectal indomethacin and sublingual GTN had the highest surface under the cumulative ranking curves (SUCRA) probability of (92.2%) and was the best preventive strategy for moderate-to-severe PEP with a SUCRA probability of (89.2%).

CONCLUSION

Combination of rectal indomethacin 100 mg with sublingual GTN offered better prevention of PEP than when used alone and could alleviate the severity of PEP.

Keywords: Endoscopic retrograde cholangiopancreatography; Pancreatitis; Diclofenac; Indomethacin; Naproxen; Glyceryl trinitrate

Core tip: Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is a common and serious complication. Several prophylactic measures have been tried. Some guidelines recommend rectal administration of 100 mg diclofenac or indomethacin as routine PEP prophylaxis. glyceryl trinitrate (GTN) has been reported as an effective drug for preventing PEP. In view of some high-quality randomized controlled trials, we conducted this network meta-analysis to compare nonsteroidal anti-inflammatory drugs and GTN for prevention of PEP and to determine whether they are better in combination. Our analysis showed that combination of rectal indomethacin 100 mg with sublingual GTN was the most effective strategy for preventing PEP and reducing its severity.