Preventive strategies for post-endoscopic retrograde cholangiopancreatography pancreatitis: A systematic review and meta-analysis

Table 1 Summary of the Included Trials

Ref.	Randomization method	Allocation concealment	Blinding	Intervention details	Intervention category	Intervention PEP	Control PEP	Effect estimate
He[6], 2016	Simple randomization	Unclear	Unclear	Indomethacin suppository 100 mg + somatostatin	NSAID-based pharmacologic prophylaxis	2/63	9/66	0.23 (0.05, 1.04)
Liu[7], 2022	Random number table	Unclear	Unclear	Indomethacin suppository 100 mg	NSAID-based pharmacologic prophylaxis	2/35	11/51	0.26 (0.06, 1.12)
Liu[8], 2024	Random number table	Unclear	Unclear	Tongyi Chengqi decoction	Traditional Chinese medicine/other	0/36	2/36	0.20 (0.01, 4.03)
Chang et al[9], 2020	Unclear	Unclear	Unclear	Pancreatic duct stent placement	Prophylactic pancreatic duct stent	2/51	13/48	0.14 (0.03, 0.61)
Zhang et al[10], 2017	Unclear	Unclear	Unclear	Pancreatic duct stent placement	Prophylactic pancreatic duct stent	5/45	18/45	0.28 (0.11, 0.68)
Yang[11], 2018	Random number table	Unclear	Unclear	Indomethacin suppository 100 mg	NSAID-based pharmacologic prophylaxis	1/35	8/35	0.12 (0.02, 0.95)
Lin et al[12], 2016	Unclear	Unclear	Unclear	Phloroglucinol injection 40 mg	Pharmacologic prophylaxis	1/19	4/19	0.25 (0.03, 2.04)
Wang[13], 2018	Random number table	Unclear	Unclear	Indomethacin suppository (timing comparison)	NSAID-based pharmacologic prophylaxis	1/40	7/40	0.14 (0.02, 1.11)
Luo[14], 2019	Computer-generated	Sealed envelopes	Single-blind	Rectal indomethacin 100 mg	NSAID-based pharmacologic prophylaxis	47/1297	100/1303	0.47 (0.34, 0.66)
Ge[15], 2016	Random number table	Unclear	Unclear	Diclofenac sodium suppository 50 mg	NSAID-based pharmacologic prophylaxis	3/50	7/50	0.43 (0.12, 1.56)
Jia et al[16], 2017	Unclear	Unclear	Unclear	Pancreatic duct stent placement	Prophylactic pancreatic duct stent	9/147	24/150	0.38 (0.18, 0.80)
Qian[17], 2020	Unclear	Unclear	Unclear	Indomethacin suppository 100 mg	NSAID-based pharmacologic prophylaxis	1/31	6/31	0.17 (0.02, 1.30)
Chen et al[18], 2021	Unclear	Unclear	Unclear	Preventive strategy (not specified)	NSAID-based pharmacologic prophylaxis	3/75	10/75	0.30 (0.09, 1.05)
Han[19], 2016	Unclear	Unclear	Unclear	Not specified	NSAID-based pharmacologic prophylaxis	16/450	30/465	0.55 (0.30, 1.00)

PEP: Post-endoscopic retrograde cholangiopancreatography pancreatitis; NSAIDs: Non-steroidal anti-inflammatory drugs.

Table 2 Major quantitative findings

Analysis	Trials	Intervention events/total	Control events/total	Pooled RR (95%CI)	Heterogeneity
Overall PEP prevention	14	93/2374	249/2414	0.38 (0.30-0.48)	I2 = 0%; P = 0.77
NSAID/pharmacologic prophylaxis	10	77/2095	192/2135	0.41 (0.32-0.52)	I2 = 0%; P = 0.85
Pancreatic duct stent	3	16/243	55/243	0.31 (0.20-0.48)	I2 = 0%; P = 0.98
Traditional Chinese medicine/other	1	0/36	2/36	0.20 (0.01-4.03)	Not applicable

RR: Risk ratio; CI: Confidence interval; PEP: Post-endoscopic retrograde cholangiopancreatography pancreatitis; NSAIDs: Non-steroidal anti-inflammatory drugs.