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Rectal NSAIDs protected better against pancreatitis than stents after ERCP
Patients who underwent endoscopic retrograde cholangiopancreatography were less likely to develop post-procedure pancreatitis when treated with rectal nonsteroidal anti-inflammatory drugs than pancreatic duct stents in a recent study.
Researchers performed a meta-analysis of 29 studies of the use of pancreatic duct (PD) stents (11 randomized controlled trials and 11 prospective/retrospective observational studies) and rectally administered nonsteroidal anti-inflammatory drugs (NSAIDs; seven randomized controlled trials) for preventing pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP). Studies appeared in PubMed and Embase before July 2012.
Both procedures were superior to placebo in preventing post-ERCP pancreatitis, with ORs of 0.24 (95% CI, 0.14-0.42) for NSAIDs and 0.5 (95% CI, 0.3-0.85) for PD stents via network meta-analysis. When used in combination, the procedures performed better than placebo (OR=0.35; 95% CI, 0.2-0.61) but not better than either procedure individually (OR=1.46; 95% CI, 0.79-2.69 vs. NSAIDs; OR=0.7; 95% CI, 0.4-1.2 vs. PD stents). Compared against each other, rectal NSAIDs were significantly more protective against pancreatitis than stents (OR=0.48; 95% CI, 0.26-0.87).
Minor heterogeneity was observed for all direct comparisons (I2<25%). Publication bias was evaluable only in the PD stents vs. placebo analysis, and possible bias was observed in this comparison via funnel plot and Egger test.
Todd H. Baron
“Post-ERCP pancreatitis has been a major cause of morbidity since ERCP was first introduced,” researcher Todd H. Baron, MD, gastroenterology and hepatology division at Mayo Clinic in Rochester, Minn., told Healio.com. “It is astounding that the problem appears to be preventable with a simplified approach. It is interesting to note that NSAIDs alone are better than pancreatic stents and NSAIDs together. This suggests that placement of PD stents induces pancreatitis in some patients. It brings home the age-old adage: ‘If you don’t need to mess with the pancreas, don’t mess with the pancreas.’ ”