Review Article

Use of NSAIDs via the Rectal Route for the Prevention of Pancreatitis after ERCP in All-Risk Patients: An Updated Meta-Analysis

Table 1

Characteristics of studies included in the meta-analysis.

StudyYearCountryNumber of patients (NSAIDs/control)InterventionDefinition of post-ERCP pancreatitisInclusion criteriaStudy designAdverse events attributed to rectal NSAID administration

Andrade-Dávila et al. [15]2015Mexico166 (82/84)Indomethacin (or placebo), rectally, 100 mg after ERCPAmylase or lipase > 3 ULN within 24 h after ERCP and abdominal painHigh-risk patientsRCT TB MCItching in the anus in 2 patients in each group and there was no mortality
Döbrönte et al. [6]2014Hungary665 (347/318)Indomethacin (or placebo), rectally, 100 mg, before ERCPAmylase and/or lipase > 3 ULN within 24 h after ERCP and abdominal painAll-risk patientsRCT TB MCNone in both groups
Elmunzer et al. [10]2012USA602 (295/307)Indomethacin (or placebo), rectally, 100 mg after ERCPAmylase > 3 ULN within 24 h after ERCP, new upper abdominal pain, and hospitalization for at least 2 nightsHigh-risk patientsRCT DB MCNone in both groups
Khoshbaten et al. [11]2008Iran100 (50/50)Diclofenac (or placebo), rectally, 100 mg after ERCPAmylase > 4 ULN, epigastric or back pain, and epigastric rebound tendernessHigh-risk patientsRCT DB SCNone in both groups
Levenick et al. [8]2016USA449 (223/226)Indomethacin (or placebo), rectally, 100 mg during ERCPLipase > 3 ULN within 24 h after ERCP and abdominal painAll-risk patientsRCT DB SCNone in both groups
Montaño et al. [16]2007Mexico150 (75/75)Indomethacin (or placebo), rectally, 100 mg before ERCPAmylase > 3 ULN, sharp pain radiating to the back, and nausea/vomitingAll-risk patientsRCT SB MCNone in both groups
Murray et al. [12]2003Scotland220 (110/110)Diclofenac (or placebo), rectally, 100 mg after ERCPAmylase > 4 ULN, epigastric or back pain, and epigastric rebound tendernessHigh-risk patientsRCT DB SCNone in both groups
Otsuka et al. [13]2012Japan104 (51/53)Diclofenac (or placebo), rectally, 50 or 25 mg, before ERCPAmylase > 3 ULN within 24 h after ERCP and abdominal painAll-risk patientsRCT DB MCNone in both groups
Patai et al.[17]2015Hungary539 (270/269)Indomethacin (or placebo), rectally, 100 mg, after ERCPAmylase > 3 ULN within 24 h after ERCPAll-risk patientsRCT DB SCNone in both groups
Shafique et al. [14]2016Pakistan108 (54/54)Diclofenac (or placebo), rectally, 100 mg, before ERCPAmylase > 4 ULN, epigastric pain with guarding and/or vomiting,All-risk patientsRCT DB SCNone in both groups
Sotoudehmanesh et al. [18]2007Iran442 (221/221)Indomethacin (or placebo), rectally, 100 mg, before ERCPAmylase > 3 ULN, epigastric or back pain, and epigastric tendernessAll-risk patientsRCT DB SCNone in both groups

NSAIDs: nonsteroidal anti-inflammatory drugs; ERCP: endoscopic retrograde cholangiopancreatography; ULN: upper limit of normal; SC: single center; MC: multicenter; SB: single blind; DB; double blind; TB: tripe blind; RCT: randomized controlled trial.