Use of NSAIDs via the Rectal Route for the Prevention of Pancreatitis after ERCP in All-Risk Patients: An Updated Meta-Analysis

The aim of this study was to assess the efficacy of the rectal administration of nonsteroidal anti-inflammatory drugs (NSAIDs) in preventing post-ERCP pancreatitis (PEP). We searched database for randomized controlled trials (RCTs) comparing periprocedural rectal administration of NSAIDs with placebo for the prevention of PEP. The rectal administration of NSAIDs significantly decreased the incidence of PEP in the whole patient population (odds ratio (OR): 0.44, 95% confidence interval (CI): 0.30-0.64, P < 0.0001), high-risk patients (OR: 0.34, 95% CI: 0.19-0.58, P = 0.0001), and all-risk patients (OR: 0.51, 95% CI: 0.31-0.84, P = 0.008). The incidence of PEP was reduced by indomethacin (OR: 0.54, 95% CI: 0.36-0.82, P = 0.004) and diclofenac (OR: 0.27, 95% CI: 0.15-0.46, P < 0.00001). The administration of NSAIDs before (OR: 0.42, 95% CI: 0.25-0.73, P = 0.002) or after (OR: 0.39, 95% CI: 0.27-0.56, P < 0.00001) ERCP reduced PEP. The NSAIDs were associated with a reduction in mild PEP (OR: 0.55, 95% CI: 0.36-0.83, P = 0.004) and moderate-to-severe PEP (OR: 0.47, 95% CI: 0.28-0.79, P = 0.004). The rectal administration of NSAIDs reduced the incidence of PEP in high-risk and all-risk patients.