Effectiveness of the pharmacological therapy to prevent post ERCP acute pancreatitis: a network meta-analysis.

IF 3.8 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Expert Review of Gastroenterology & Hepatology Pub Date : 2024-04-01 Epub Date: 2024-05-09 DOI:10.1080/17474124.2024.2345640

Edgar Julián Rojas-Victoria, Sara Isabel Hernández-Ruiz, Herney Andrés García-Perdomo

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引用次数: 0

Abstract

Objective: To determine the effectiveness of the different pharmacological agents in preventing post-ERCP acute pancreatitis.

Methods: We included clinical trials of pharmacological interventions for prophylaxis of acute post-ERCP pancreatitis. The event evaluated was acute pancreatitis. We conducted a search strategy in MEDLINE (OVID), EMBASE, and Cochrane Central Register of Controlled Trials from inception to nowadays. We reported the information in terms of relative risks (RR) with a 95% confidence interval. We assessed the heterogeneity using the I² test.

Results: We included 84 studies for analysis (30,463 patients). The mean age was 59.3 years (SD ± 7.01). Heterogeneity between studies was low (I2 = 34.4%) with no inconsistencies (p = 0.2567). Post ERCP pancreatitis was less in prophylaxis with NSAIDs (RR 0.65 95% CI [0.52 to 0.80]), aggressive hydration with Lactate Ringer (RR 0.32 95% CI [0.12-0.86]), NSAIDs + isosorbide dinitrate (RR 0.28 95% CI [0.11-0.71]) and somatostatin and analogues (RR 0.54 [0.43 to 0.68]) compared with placebo.

Conclusions: NSAIDs, the Combination of NSAIDs + isosorbide dinitrate, somatostatin and analogues, and aggressive hydration with lactate ringer are pharmacological strategies that can prevent post-ERCP pancreatitis when compared to placebo. More clinical trials are required to determine the effectiveness of these drugs.

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预防ERCP术后急性胰腺炎的药物治疗效果：网络荟萃分析。

目的确定不同药物在预防ERCP术后急性胰腺炎方面的有效性：我们纳入了预防ERCP术后急性胰腺炎的药物干预临床试验。评估的事件为急性胰腺炎。我们在 MEDLINE (OVID)、EMBASE 和 Cochrane Central Register of Controlled Trials 中进行了检索。我们以相对风险（RR）和 95% 置信区间报告了相关信息。我们使用 I2 检验评估了异质性：我们纳入了 84 项研究进行分析（30463 名患者）。平均年龄为 59.3 岁（SD ± 7.01）。研究之间的异质性较低（I2 = 34.4%），无不一致性（P = 0.2567）。与安慰剂相比，使用非甾体抗炎药（RR 0.65 95% CI [0.52-0.80]）、乳酸林格（RR 0.32 95% CI [0.12-0.86]）、非甾体抗炎药+二硝酸异山梨酯（RR 0.28 95% CI [0.11-0.71]）和体生长抑素及类似物（RR 0.54 [0.43-0.68]）预防ERCP术后胰腺炎的发生率较低：结论：与安慰剂相比，非甾体抗炎药、非甾体抗炎药 + 二硝酸异山梨酯组合、体生长抑素和类似物以及乳酸振荡器积极补液是可以预防 ERCP 术后胰腺炎的药物策略。要确定这些药物的有效性，还需要更多的临床试验。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Expert Review of Gastroenterology & Hepatology GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

6.80

自引率

2.60%

发文量

审稿时长

6-12 weeks

期刊介绍： The enormous health and economic burden of gastrointestinal disease worldwide warrants a sharp focus on the etiology, epidemiology, prevention, diagnosis, treatment and development of new therapies. By the end of the last century we had seen enormous advances, both in technologies to visualize disease and in curative therapies in areas such as gastric ulcer, with the advent first of the H2-antagonists and then the proton pump inhibitors - clear examples of how advances in medicine can massively benefit the patient. Nevertheless, specialists face ongoing challenges from a wide array of diseases of diverse etiology.