BACKGROUND AND AIMS:
Diclofenac and indomethacin are the most studied drugs for preventing post-ERCP pancreatitis (PEP). However, there are no prospective, randomized multicenter trials with sufficient number of patients for the correct evaluation of their efficacy. Our aim was to evaluate of all trials published in full text and studied efficacy of diclofenac or indomethacin prospective controlled with placebo or non-treatment for the prevention of PEP in adult patients undergoing ERCP.
Systematic search of databases (PubMed, Scopus, Web of Science, Cochrane) for relevant studies published from inception to 30 June 2016.
Our meta-analysis of 4741 patients from 17 trials showed that diclofenac or indomethacin significantly decreased the risk ratio (RR) of PEP to 0.60 (95% confidence interval [CI], 0.46 - 0.78; P = 0.0001), number needed to treat (NNT) was 20, and the reduction of RR of moderate to severe PEP was 0.64 (95% CI, 0.43 - 0.97; P = 0.0339). The efficacy of indomethacin compared with diclofenac was similar (P = 0.98). The efficacy of indomethacin or diclofenac did not differ according to timing (P = 0.99) nor between patients with average-risk and high-risk for PEP (P = 0.6923). The effect of non-rectal administration of indomethacin or diclofenac was not significant (P = 0.1507), but rectal route was very effective (P = 0.0005) with a NNT of 19. The administration of indomethacin or diclofenac was avoided in patients with renal failure. Substantial adverse events were not detected.
The use of rectally administered inexpensive and safe diclofenac or indomethacin before or closely after ERCP is recommended in every patient (without renal failure) undergoing ERCP.