Shi QQ, Huang GX, Li W, Yang JR, Ning XY. Rectal nonsteroidal anti-inflammatory drugs, glyceryl trinitrate, or combinations for prophylaxis of post-endoscopic retrograde cholangiopancreatography pancreatitis: A network meta-analysis. World J Clin Cases 2022; 10(22): 7859-7871 [PMID: 36158503 DOI: 10.12998/wjcc.v10.i22.7859]
Corresponding Author of This Article
Jian-Rong Yang, MD, MMed, Chief Physician, Department of Hepatobiliary, Pancreas and Spleen Surgery, the People's Hospital of Guangxi Zhuang Autonomous Region, No.6 Taoyuan Road, Qingxiu District, Nanning City 530021, Guangxi Zhuang Autonomous Region, China. 1637340358@qq.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Meta-Analysis
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Aug 6, 2022; 10(22): 7859-7871 Published online Aug 6, 2022. doi: 10.12998/wjcc.v10.i22.7859
Rectal nonsteroidal anti-inflammatory drugs, glyceryl trinitrate, or combinations for prophylaxis of post-endoscopic retrograde cholangiopancreatography pancreatitis: A network meta-analysis
Qing-Qing Shi, Guo-Xiu Huang, Wei Li, Jian-Rong Yang, Xiao-Yi Ning
Qing-Qing Shi, Guo-Xiu Huang, Wei Li, Department of Health Management Center, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Jian-Rong Yang, Department of Hepatobiliary, Pancreas and Spleen Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Xiao-Yi Ning, Department of Hematology, The Frist People’s Hospital of Nanning, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Author contributions: Yang JR and Li W designed the study; Li W and Huang GX carried out critical appraisal of the included studies; Shi QQ and Ning XY performed the literature search, extracted the data; Shi QQ wrote the manuscript; Yang JR and Huang GX helped to revise the manuscript; all authors critically reviewed the manuscript and approved this study to be published.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jian-Rong Yang, MD, MMed, Chief Physician, Department of Hepatobiliary, Pancreas and Spleen Surgery, the People's Hospital of Guangxi Zhuang Autonomous Region, No.6 Taoyuan Road, Qingxiu District, Nanning City 530021, Guangxi Zhuang Autonomous Region, China. 1637340358@qq.com
Received: November 10, 2021 Peer-review started: November 10, 2021 First decision: December 3, 2021 Revised: December 4, 2021 Accepted: July 5, 2021 Article in press: July 5, 2022 Published online: August 6, 2022
ARTICLE HIGHLIGHTS
Research perspectives
Clinical application of drugs.
Research conclusions
The combination of rectal indomethacin 100 mg with sublingual glyceryl trinitrate (GTN) offered better prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) than when used alone and could alleviate the severity of PEP. This conclusion needs to be explored in more randomized controlled trials (RCTs) with large samples.
Research results
Twenty-four eligible RCTs were selected, evaluating seven preventive strategies in 9416 patients. Rectal indomethacin 100 mg plus sublingual GTN, rectal diclofenac 100 mg, sublingual GTN, and rectal indomethacin 100 mg were all more efficacious than placebo in preventing PEP. The combination of rectal indomethacin and sublingual GTN had the highest surface under the cumulative ranking curves (SUCRA) probability of 92.2% and was the best preventive strategy for moderate-to-severe PEP with a SUCRA probability of 89.2%.
Research methods
A systematic search was done for full-text RCTs of PEP in PubMed, Embase, Science Citation Index, and the Cochrane Controlled Trials database. Inclusion and exclusion criteria were used to screen for eligible RCTs. The major data were extracted by two independent reviewers. The Frequentist model was used to conduct this network meta-analysis and obtain the pairwise odds ratios and 95%CI.
Research objectives
To compare NSAIDs and GTN in the prevention of PEP and to determine whether they are better in combination.
Research motivation
To explore the role of NSAIDs and GTN for prevention of PEP.
