| Objective: The aim of the study is to assess the effectivenessand safety of Diclofenac and Indomethacin, two of routine-used drugs inNSAIDs, in preventing post-Endoscopic Retrograde Cholangiopancreatographypancreatitis(PEP). The purpose is to provide reference for clinical mediation ofPEP. Methods: Firstly, we established the searching strategy. Then theelectronic searches were conducted to retrieve Randomized Controlled trials(RCTs) from The Cochrane Library,PubMed, Embase, OVID, China BiologicalMedicine Database(CBM), Chinese Journals full-text Database(CNKI),Chinese Technological Journals Database(VIP) and Wan Fang Digital JournalFull-text Database. Secondly,12kinds of specific Chinese journals likeChinese Journal of Gastroenterology and conference proceedings werehand-searched till June2011, and all references in all included trials weresearched, too. The RCTs on Diclofenac and Indomethacin for preventing PEPwere identified and retrieved in worldwide. Then we made strict including andexcluding criterions and assessed the risk bias of the RCTs. Two reviewersextracted and cross checked datas independently. Finally, statistical analysiswas performed by Meta analysis using Revman5.1which offered by Cochrane.Result:(1)Diclofenac: A total of5trials involving675patients were included.2trials each had two high risk bias and2trials had many unclear risk bias. ①The Meta-analysis showed that Diclofenac might reduce the incidence ofPEP(OR=0.41,95%CI:0.18-0.95,P=0.04), but sensitivity and ITT analysisindicated the result was not stable.②The result of the subgroup analysis wasthat the rectal administration of Diclofenac could decrease the incidence of PEPsignificantly(OR=0.24,95%CI:0.11-0.50,P=0.0002). The subgroup analysis ofthe trials whose diagnostic criteria of PEP was serum amylase after ERCPreaching to more than four times of high-normal value showed that the differentincidence of PEP between the two groups was significant(OR=0.26,95%CI:0.12-0.57,P=0.0007).③No evidence showed Diclofenac can reduce the incidenceof severe PEP(OR=0.40,95%CI:0.08-2.06,P=0.27).④The mortality of PEPwas0%in3trials.⑤No adverse reaction events related to the drug werereported.(2)Indomethacin: A total of3trials involving700patients wereincluded. one trials had two high risk bias and the others had many unclear riskbias.①The Meta-analysis showed that Indomethacin could reduce theincidence of PEP significantly(OR=0.34,95%CI:0.18-0.65,P=0.001) andsensitivity analysis consisted with the result, but not ITT analysis.②Indomethacin had no efficacy for severe PEP(OR=0.14,95%CI:0.02-1.14,P=0.07).③The mortality of PEP was0%in all included trials.④No adversereaction happened. Conclusion:(1)Diclofenac may be safe and effective inreducing the incidence of PEP. The result maybe related to the mode of druguse and diagnostic criteria of PEP. But we should be cautiously to deal with the conclusion because of its instability. Diclofenac has no significant effect onpreventing severe PEP.(2)Short-term application of Indomethacin is relativelysafe. Indomethacin may be effective for preventing PEP, but not reduce theincidence of severe PEP significantly.(3)The prognosis of PEP is fine.Considering the methodological and scale limitation and heterogeneity ofincluded studies and the in evitable bias of meta analysis, we should explain theconclusion carefully. More RCTs with large-scale and high-quality are requiredin future researches. |
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