The efficacy of many pharmacological agents for preventing post-ERCP pancreatitis (PEP) has been evaluated in randomised controlled trials (RCTs), but it is unclear which agent(s) should be used in clinical practice.
Network meta-analyses of RCTs are used to simultaneously compare several agents to determine their relative efficacy and identify priority agents for comparison in future RCTs.
Dr Singh and colleagues from Maryland, USA evaluated pharmacological agents for the prevention of PEP by conducting a network meta-analysis of RCTs.
The team searched MEDLINE, EMBASE and Cochrane Library databases for RCTs that evaluated the efficacy of agents for preventing PEP.
RCTs were simultaneously analysed using random-effects network meta-analysis under the Bayesian framework to identify the best agents.
|Patients receiving topical epinephrine had a 75% reduced risk of PEP|
|Alimentary Pharmacology & Therapeutics|
The researchers ordere the efficacy of agents according to the probability of being ranked as any of the top three best performing agents.
The network meta-analysis included 99 RCTs evaluating 16 agents in 25,313 patients.
The research team found that topical epinephrine (adrenaline) was the most efficacious agent with 86% probability of ranking among the top 3 agents, followed by nafamostat, antibiotics, and NSAIDs.
However, in a sensitivity analysis including only rectal NSAIDs, NSAIDs moved from fourth rank to second.
The team noted that patients receiving topical epinephrine, compared with placebo, had a 75% reduced risk of PEP.
Dr Singh's team commented, "Topical epinephrine and rectal NSAIDs are the most efficacious agents for preventing post-ERCP pancreatitis, based on existing RCTs."
"Combinations of these agents, which act on different steps in the pathogenesis of post-ERCP pancreatitis, should be evaluated in future trials."