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Rectal NSAIDs are superior to pancreatic duct stents in preventing pancreatitis after ERCP

Rectal nonsteroidal anti-inflammatory drugs are superior to pancreatic duct stents in preventing pancreatitis after endoscopic retrograde cholangiopancreatography, reports the most recent issue of the Clinical Gastroenterology & Hepatology.

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Placement of pancreatic duct stents prevents pancreatitis after endoscopic retrograde cholangiopancreatography.

There is evidence that rectal administration of nonsteroidal anti-inflammatory drugs also prevents post-endoscopic retrograde cholangiopancreatography pancreatitis, but the 2 approaches alone have not been compared directly.

Dr Ali Akbar from Minnesota, USA conducted a network meta-analysis to indirectly compare the efficacies of these procedures.

The team searched PubMed and Embase by 2 independent reviewers to identify full-length clinical studies, published in English, investigating use of pancreatic duct stent placement, and rectal nonsteroidal anti-inflammatory drugs to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis.

The team identified 29 studies.

The researchers used network meta-analysis to compare rates of post-endoscopic retrograde cholangiopancreatography pancreatitis among patients who received only rectal nonsteroidal anti-inflammatory drugs, only pancreatic duct stents, or both.

The combination of rectal NSAIDs with rectal stents was not superior to either approach alone
Clinical Gastroenterology and Hepatology

Placement of pancreatic duct stents and rectal administration of nonsteroidal anti-inflammatory drugs were each superior to placebo in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis.

The combination of rectal nonsteroidal anti-inflammatory drugs and stents was not superior to either approach alone.

The doctors assessed that the pooled results showed that rectal nonsteroidal anti-inflammatory drugs alone were superior to pancreatic duct stents alone in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis.

Dr Akbar's team commented, "Based on a network meta-analysis, rectal nonsteroidal anti-inflammatory drugs alone are superior to pancreatic duct stents alone in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis, and should be considered first-line therapy for selected patients."

"However, these findings were limited by the small number of studies assessed, potential publication bias, and the indirect nature of the comparison."

"High-quality, randomized, controlled trials are needed to compare these 2 interventions and confirm these findings."

Clin Gastroenterol and Hepatol 2013: 11(7) :778-783
15 July 2013

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