A Meta Analysis Of Gabexate In The Prophylaxis Of Post-endoscopic Retrograde Cholangiopancreatography Pancreatitis

Objectives Acute pancreatitis is the most common complication ofendoscopic retrograde cholangiopancreatography (ERCP). Gabexate, as akind of protease inhibitors, has been used in the researches for theprevention of post-endoscopic retrograde cholangiopancreatographypancreatitis (PEP). Previous clinical trials showed us different results. Sothe discrepancy about the prophylactic effect of gabexate still exists. Thisstudy aimed to evaluate the effectiveness and safety of gabexate in theprophylaxis of PEP with the method of meta analysis.Methods Cochrane systematic evaluation was used in this study. Wesearch literatures from Cochrane Library, EMBASE, PubMed, CNKI, VIP,CBM and WanFang Data on the internet. We also searched literatures fromother sources by hand. Two researchers extracted datas from the enrolledliteratures. The literature quality was independently evaluated andcross-checked by two researchers according to the Jadad scale. Thesoftware RevMan5.2of Cochrane Collaboration was used for statisticalanalysis. Results According to the retrieval strategy, the inclusion andexclusion criterias, a total of10trials involving3235cases were included.All of the trials are randomized controlled trials. Meta analysis showed thatcompared to control group, the gabexate group had a statistical significancein the decrease of the incidence of PEP (OR=0.56，95%CI:0.34~0.93，P=0.02) and post-ERCP hyperamylasemia (PEHA)(OR=0.82，95%CI:0.67~0.99，P=0.04), but had no statistical significance in the incidenceof severe acute pancreatitis (SAP) after ERCP (OR=0.81，95%CI:0.29~2.25，P=0.69）and post-ERCP abdominal pain（OR=0.93，95%CI:0.64~1.36，P=0.70). In the subgroup analysis, the results showedthat the use of high dose of gabexate (≥1g) with long duration (≥12h) canprevent PEP (OR=0.44，95%CI:0.24~0.78， P=0.005）， post-ERCPabdominal pain （OR=0.43，95%CI:0.25~0.77， P=0.004）and PEHA（OR=0.7，95%CI:0.50~0.96，P=0.03）.Conclusions Gabexate is effective in the prophylaxis of PEHA, but isineffective in reducing the incidence of SAP after ERCP. Gabexateadministered as a high dose with long duration seems to be an effectivemeasure to prevent PEP, PEHA and post-ERCP abdominal pain. The use ofgabexate is safe. More clinical trials with high quality and with largesample size need to be conducted to evaluate the effect of gabexate.