Research Article

Rectal Indomethacin Is Protective against Pancreatitis after Endoscopic Retrograde Cholangiopancreatography: Systematic Review and Meta-Analysis

Table 1

Characteristics of included studies in the meta-analysis.

StudyYearCountryType of trialPatients (T/C)InterventionDefinition of PEP

Sotoudehmanesh et al. [14]2007IranDouble-blind randomized trial245/245100 mg rectal indomethacin versus inert suppository; before ERCPSerum amylase more than 3 times the upper limit of normal associated with epigastric pain, back pain, and epigastric tenderness
Montaño Loza et al. [21]2007MexicoRandomized controlled trial75/75100 mg rectal indomethacin versus rectal glycerine; before ERCPAmylase level 3 times the upper limit of normal and epigastric pain or throughout the abdomen radiating to back associated with nausea or vomiting
Döbrönte et al. [19]2012HungaryProspective randomized clinical trial130/98100 mg rectal indomethacin versus inert placebo; before ERCPAmylase level 3 times the upper limit of normal and epigastric pain or throughout the abdomen radiating to back associated with nausea or vomiting
Elmunzer et al. [4]2012AmericanMulticentre, randomized, placebo-controlled, double-blind clinical trial295/3072 ∗ 50 mg rectal indomethacin versus placebo suppository; after ERCPAmylase level 3 times the upper limit of normal and epigastric pain or throughout the abdomen radiating to back associated with nausea or vomiting
Döbrönte et al. [18]2014HungaryMulticentre prospective, randomized, controlled trial347/318100 mg, rectal indomethacin versus placebo suppository; before ERCPAmylase level 3 times the upper limit of normal and epigastric pain or throughout the abdomen radiating to back associated with nausea or vomiting
Patai et al. [5]2015HungaryProspective, placebo-controlled, double-blind trial270/269100 mg rectal indomethacin versus placebo suppository; before ERCPAbdominal pain, extended hospitalization 2–3 days, elevation of amylase 3 times the upper limit of normal in 24 hours
Andrade-Dávila et al. [9]2015MexicoProspective randomized controlled trial82/84100 mg rectal indomethacin versus glycerine; after ERCPNew or increased abdominal pain consistent with pancreatitis, elevated amylase or lipase greater than three times the normal upper limit until 24 hours after the procedure, and hospitalization (or prolongation of existing hospitalization) for at least 2 nights
Levenick et al. [8]2016AmericaProspective, double-blind, placebo-controlledtrial223/226100 mg rectal indomethacin versus placebo suppository; during the ERCPNew upper abdominal pain, an elevated lipase greater than three times the upper limit of the normal 24 hours after the onset of pain, and hospitalization for at least two nights
Hosseini et al. [20]2016IranRandomized controlled trial100/105100 mg rectal indomethacin versus glycerine; before ERCPNew onset or worsened abdominal pain, increase in serum amylase at least 3 times above the upper limit of normal measured 24 h after the procedure, and need for more than one night of hospitalization
Luo et al. [11]2016ChinaMulticentre, single-blinded, randomized controlled trial1297/1303100 mg rectal indomethacin versus no treatment; before ERCPNew onset of upper abdominal pain associated with an elevated serum amylase of at least three times the upper limit of normal range at 24 h after the procedure and admission to a hospital for at least 2 nights

ERCP: endoscopic retrograde cholangiopancreatography; T/C: treatment/control.