Pharmacologic prophylaxis of post-endoscopic retrograde cholangiopancreatography pancreatitis: Protease inhibitors and NSAIDs in a meta-analysis

Hiroki Yuhara, Masami Ogawa, Yoshiaki Kawaguchi, Muneki Igarashi, Tooru Shimosegawa, Tetsuya Mine

Research output: Contribution to journalReview articlepeer-review

52 Citations (Scopus)

Abstract

Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis is the most frequent complication of ERCP. Several meta-analyses have examined the effects of protease inhibitors (gabexate mesilate, ulinastatin, and nafamostat mesilate) and non-steroidal anti-inflammatory drugs (NSAIDs) on post-ERCP pancreatitis, but the results have been confusing. Since the previous meta-analysis, several new studies have been published on this topic. To provide an updated quantitative assessment of the effectiveness of protease inhibitors and NSAIDs in preventing post-ERCP pancreatitis, we conducted a meta-analysis of randomized trials for patients at risk of post-ERCP pancreatitis. Twenty-six articles were included in this meta-analysis. Nafamostat mesilate (summary RR = 0.41; 95 %CI 0.28-0.59; n = 4 studies) and NSAIDs (summary RR = 0.58; 95 %CI = 0.44-0.76; n = 7 studies) were associated with decreased risk of post-ERCP pancreatitis in the high-quality studies. However, gabexate mesilate (summary RR = 0.64; 95 %CI = 0.36-1.13; n = 6 studies) and ulinastatin (summary RR = 0.65; 95 %CI = 0.33-1.30; n = 2 studies) were not associated with decreased risk of post-ERCP pancreatitis in the high-quality studies. This is the first meta-analysis to compare the effects of three protease inhibitors. Solid evidence supports the use of nafamostat mesilate and NSAIDs for preventing post-ERCP pancreatitis.

Original languageEnglish
Pages (from-to)388-399
Number of pages12
JournalJournal of gastroenterology
Volume49
Issue number3
DOIs
Publication statusPublished - 2014 Mar

Keywords

  • Gabexate mesilate
  • NSAIDs
  • Nafamostat mesilate
  • Post-ERCP pancreatitis
  • Protease inhibitor
  • Ulinastatin

ASJC Scopus subject areas

  • Gastroenterology

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