Effectiveness of nonsteroidal anti-inflammatory drugs in prevention of post-ERCP pancreatitis: A meta-analysis

Table 1 Characteristics of the included articles n (%)

Ref.	Year	Country	Setting	Number of patients	NSAID dose and duration	PEP in NSAID group	PEP in placebo group
Murray et al[18]	2003	Scotland	Single center	220	Suppository, 100 mg after ERCP	7 (6.4)	17 (15.5)
Cheon et al[17]	2007	United States	Single center	207	Oral, 50 mg before and after ERCP	17 (16.2)	17 (16.7)
Sotoudehmanesh et al[9]	2007	Iran	Single center	480	Suppository, 100 mg before ERCP	7 (2.8)	15 (6.1)
Montaño Loza et al[19]	2007	Mexico	Single center	150	Suppository, 100 mg before ERCP	4 (5.3)	-
Khoshbaten et al[16]	2008	Iran	Single center	100	Suppository, 100 mg after ERCP	2 (4.0)	13 (26.0)
Senol et al[15]	2009	Turkey	Single center	80	Infusion, 75 mg after ERCP	3 (7.5)	7 (17.5)
Elmunzer et al[14]	2012	United States	Multi-center	602	Suppository, 50 mg after ERCP	27 (9.1)	52 (25.1)
Otsuka et al[5]	2012	Japan	Single center	104	Suppository, 50 mg before ERCP	2 (3.9)	10 (18.9)

ERCP: Endoscopic retrograde cholangiopancreatography; NSAID: Nonsteroidal anti-inflammatory drug; PEP: Post-endoscopic retrograde cholangiopancreatography pancreatitis.

Table 2 Quality assessments of the included studies

Ref.	Random sequence generation	Allocation concealment	Blinding of participants and personnel	Blinding of outcome	Incomplete outcome data	Selective reporting
Murray et al[18]	Mentioned, not described	Described	Mentioned, not described	Not mentioned	Completed	Not mentioned
Cheon et al[17]	Described	Described	Mentioned, not described	Mentioned, not described	Completed	Not mentioned
Sotoudehmanesh et al[9]	Mentioned, not described	Mentioned, not described	Mentioned, not described	Described	Completed	Not mentioned
Montaño Loza et al[19]	Mentioned, not described	Not mentioned	Not mentioned	Not mentioned	Completed	Not mentioned
Khoshbaten et al[16]	Mentioned, not described	Not mentioned	Mentioned, not described	Not mentioned	Completed	Not mentioned
Senol et al[15]	Mentioned, not described	Not mentioned	Not mentioned	Not, mentioned	Completed	Not mentioned
Elmunzer et al[14]	Mentioned, not described	Not mentioned	Described	Described	Completed	Not mentioned
Otsuka et al[5]	Mentioned, not described	Mentioned, not described	Not mentioned	Not mentioned	Completed	Not mentioned

Table 3 Subgroup and sensitivity analyses to evaluate the effect of nonsteroidal anti-inflammatory drug administration on post-endoscopic retrograde cholangiopancreatography pancreatitis prevention

Trials	Subgroup (n)	RR (95%CI)	Z	P value	Heterogeneity
					χ2	P	I2(%)
The overall effect of NSAIDs on PEP
All forms	8 studies (1883)	0.43 (0.33-0.56)	6.18	< 0.0001	10.68	0.15	34
Different administration routes
Suppository	6 studies (1596)	0.35 (0.26-0.48)	6.47	< 0.0001	2.72	0.74	0
Oral	1 study (207)	0.97 (0.53-1.80)	0.09	0.93	-	-	-
Infusion	1 study (80)	0.43 (0.12-1.54)	1.30	0.19	-	-	-
Different definitions of PEP
The same criteria	6 studies (1563)	0.46 (0.34-0.61)	5.24	< 0.0001	8.38	0.14	40
Others	2 studies (320)	0.30 (0.15-0.61)	3.31	0.001	1.38	0.24	27
Different research settings
Single center	7 studies (1381)	0.47 (0.33-0.66)	4.27	< 0.0001	9.45	0.15	37
Multi-center	1 study (502)	0.36 (0.24-0.56)	4.61	< 0.0001	-	-	-
Different dosages
100 mg	4 studies (990)	0.36 (0.22-0.59)	4.05	< 0.0001	2.15	0.54	0
75 mg	1 study (80)	0.43 (0.12-1.54)	1.30	0.19	-	-	-
50 mg	3 studies (813)	0.47 (0.33-0.65)	4.49	< 0.0001	7.91	0.02	75

NSAID: Nonsteroidal anti-inflammatory drug; PEP: Post-endoscopic retrograde cholangiopancreatography pancreatitis.