Comparative effectiveness of pharmacologic and endoscopic interventions for prevention of post-ERCP pancreatitis: a network meta-analysis

Authors

Basile Njei, Section of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut, United States.
Thomas R. McCarty, Department of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, United States.
Thiruvengadam Muniraj, Section of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut, United States.
Prabin Sharma, Department of Gastroenterology and Hepatology, Yale New Haven Health-Bridgeport Hospital, Bridgeport, Connecticut, United States.
Priya A. Jamidar, Section of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut, United States.
Harry R. Aslanian, Section of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut, United States.
Shyam Varadarajulu, Center for Interventional Endoscopy, Florida Hospital, University of Central Florida College of Medicine, Orlando, Florida, United States.
Udayakumar Navaneethan, Center for Interventional Endoscopy, Florida Hospital, University of Central Florida College of Medicine, Orlando, Florida, United States.

Document Type

Article

Publication Title

Endoscopy international open

Abstract

While several interventions may decrease risk of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis, it remains unclear whether one strategy is superior to others. The purpose of this study was to compare the effectiveness of pharmacologic and endoscopic interventions to prevent post-ERCP pancreatitis among high-risk patients. A systematic review was performed to identify randomized controlled trials from PubMed, Embase, Web of Science, and Cochrane database through May 2017. Interventions included: rectal non-steroidal anti-inflammatory drugs (NSAIDs), aggressive hydration with lactated ringer's (LR) solution, and pancreatic stent placement compared to placebo. Only studies with patients at high-risk for post-ERCP pancreatitis were included. Bayesian network meta-analysis was performed and relative ranking of treatments was assessed using surface under the cumulative ranking (SUCRA) probabilities.  We identified 29 trials, comprising 7,862 participants comparing four preventive strategies. On network meta-analysis, compared with placebo, rectal NSAIDs (B = - 0.69, 95 % CI [-1.18; - 0.21]), pancreatic stent (B = - 1.25, 95 % CI [-1.81 to -0.69]), LR (B = - 0.67, 95 % CI [-1.20 to -0.13]), and combination of LR plus rectal NSAIDs (B = - 1.58; 95 % CI [-3.0 to -0.17]), were all associated with a reduced risk of post-ERCP pancreatitis. Pancreatic stent placement had the highest SUCRA probability (0.81, 95 % CI [0.83 to 0.80]) of being ranked the best prophylactic treatment.  Based on this network meta-analysis, pancreatic stent placement appears to be the most effective preventive strategy for post-ERCP pancreatitis in high-risk patients.

First Page

E29

Last Page

E40

DOI

10.1055/a-1005-6366

Publication Date

1-1-2020

Recommended Citation

Njei, Basile; McCarty, Thomas R.; Muniraj, Thiruvengadam; Sharma, Prabin; Jamidar, Priya A.; Aslanian, Harry R.; Varadarajulu, Shyam; and Navaneethan, Udayakumar, "Comparative effectiveness of pharmacologic and endoscopic interventions for prevention of post-ERCP pancreatitis: a network meta-analysis" (2020). Randomized Controlled Trial. 17.
https://scholar.bridgeporthospital.org/randomized_trial/17

Identifier

31921982 (pubmed); PMC6949176 (pmc); 10.1055/a-1005-6366 (doi)