Post-endoscopic retrograde cholangiopancreatography pancreatitis: A systematic review for prevention and treatment

Table 2 Brief contents of reviewed articles on rectal indomethacin

Authors	Year	Country	n	Intervention	Design	Incidence of PEP1				P value
						Study group		Control (compared)
Elmunzer et al[60]	2012	United States	602	2 × 50-mg indomethacin or 2 × placebo right after ERCP	Prospective, multicenter, placebo-controlled, double-blind	27/295 (9.2%) [IND]		52/307 (16.9%) [Placebo]		0.005
Döbrönte et al[65]	2014	Hungary	665	100 mg indometha-cin or an placebo 10-15 min prior to ERCP	Prospective, multicenter, placebo- controlled	20/347 (5.76%) [IND]		22/318 (6.92%) [Placebo]		0.541
Patai et al[61]	2015	Hungary	539	100 mg indomethacin or placebo 1 h prior to ERCP	Prospective, single center, placebo-controlled, double-blind	18/270 (6.7%) [IND]		37/269 (13.8%) [Placebo]		0.406
Andrade-Davila et al[56]	2015	Mexico	166	100 mg of indomethacin or 2.6 g suppository of glycerin right after ERCP	Prospective, single center, placebo-controlled	4/82 (4.87%) [IND]		17/84 (20.23%) [GS]		0.01
Luo et al[62]	2016	China	2600	100 mg indomethacin for unselected patients within 30 min prior to ERCP or 100 mg indomethacin just after ERCP for patients with high risks	Prospective, multicenter, single-blind	47/1297 (4%) [Universal IND]		100/1303 (8%) [Risk-stratified IND]		< 0.001
Levenick et al[58]	2016	United States	449	100 mg indomethacin or placebo during ERCP	Prospective, single center, double-blind, placebo-controlled	16/223 (7.2%) [IND]		11/226 (4.9%) [Placebo]		0.33
Hosseini et al[63]	2016	Iran	406	100 mg indomethacin two hours before the ERCP or 1 L of ISP within 2 h before ERCP and 2 L within 16 h after ERCP or indomethacin and ISP or 2 g of glycerin in suppositories	Prospective, single center, blinded subject data	11/100 (11%) [IND]	10/100 (10%) [ISP]	0/101 (0) [IND+ISP]	17/105 (16%) [RG]	-
Mok et al[64]	2017	United States	192	LR + IND, NS + IND, LR + placebo or NS + placebo	Prospective, single center, double-blind, placebo-controlled	3/48 (6%) [LR+IND]	6/48 (13%) [NS+IND]	9/48 (19%) [LR+Placebo]	10/48 (21%) [NS+Placebo]	0.04

¹The fractional ratios are “Number of PEP incidences/number of patients in the group”. Rate of PEP incidences are given in the parenthesis. Definitions of the procedures applied to groups are given in the brackets. n: Number of patients (sample size); IND: Indomethacin; ISP: Intravenous (IV) saline perfusion; RG: Rectal glycerin; LR: Lactated ringer’s solution; NS: Standard normal saline solution; GS: Glycerin suppository.