A meta-analysis of NSAIDs in the prevention of post-ERCP pancreatitis.Elmunzer BJ, Waljee AK, Elta GH, Taylor JR, Fehmi SM, Higgins PD. Gut. 2008 Mar 28 [Epub ahead of print] BACKGROUND: Several pharmacologic agents for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) have been studied. Clinical trials evaluating the protective effect of non-steroidal anti-inflammatory drugs (NSAIDs) have yielded inconclusive results.

AIM: To perform a meta-analysis of studies evaluating the effect of prophylactic rectal NSAIDs on PEP. METHODS: By searching Medline, Embase, meeting abstracts, and bibliographies, two independent reviewers systematically identified prospective randomized controlled trials (RCTs) examining the effect of rectally administered prophylactic NSAIDs on the incidence of PEP.

A meta-analysis of these clinical trials was performed. RESULTS: Four RCTs, enrolling a total of 912 patients, have been published. Meta-analysis of these studies demonstrates a pooled relative risk for PEP after prophylactic administration of NSAIDs of 0.36 (95% confidence interval 0.22 - 0.60); patients who received NSAIDs in the peri-procedural period were 64% less likely to develop pancreatitis and 90% less likely to develop moderate to severe pancreatitis. The pooled number needed to treat with NSAIDs to prevent one episode of pancreatitis is 15 patients. No adverse events attributable to the use of NSAIDs were reported in any of the clinical trials. CONCLUSION: In this meta-analysis, prophylactic NSAIDs were effective in preventing post-ERCP pancreatitis. Widespread prophylactic administration of these agents may significantly reduce the incidence of PEP, resulting in major clinical and economic benefit. Given current skepticism regarding the efficacy of any prophylactic medication for ERCP, additional multi-center studies are needed for confirmation prior to widespread adoption of this strategy.

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