SNFGE SNFGE
 
Thématique :
- MICI
Originalité :
Réexamen
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Docteur Florian ROSTAIN
Coup de coeur :
 
 
Gastrointestinal Endoscopy
  2017/02  
 
  2017 Feb. pii: S0016-5107(17)30077-9  
  doi: 10.1016/j.gie.2017.01.033.  
 
  Indomethacin and diclofenac in the prevention of post-ERCP pancreatitis: a systematic review and meta-analysis of prospective controlled trials.  
 
  Patai Á, Solymosi N, Mohácsi L, Patai ÁV  
  https://www.ncbi.nlm.nih.gov/pubmed/28167118  
 
 

Abstract

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.

METHODS:

Systematic search of databases (PubMed, Scopus, Web of Science, Cochrane) for relevant studies published from inception to 30 June 2016.

RESULTS:

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.

CONCLUSIONS:

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.

 

  
Question posée
 
Quelle est l’efficacité du diclofénac et de l’indométacine dans la prévention de la pancréatite aigüe post-CPRE par rapport au placebo ou l’absence de traitement ?
  
Question posée
 
Méta-analyse sur 17 études incluant 4741 patients. Le diclofénac et l’indométacine diminuent significativement le risque de pancréatite aigüe post CPRE avec un risque relatif RR à 0,60 (95% intervalle de confiance [IC], 0,46 – 0,78; P = 0,0001). Les efficacités du diclofénac et de l’indométacine sont similaires. Il n’y avait pas de différence significative concernant le moment auquel le traitement était administré. Seule la voie intra-rectale a montré un effet significatif.
  
Commentaires

Le diclofénac et l’indométacine administrés par voie intra-rectale diminuent le risque de pancréatite aigüe post CPRE.
Certaines études tendent toutefois à prouver que l’administration doit être réalisée avant ou en tout début de geste pour diminuer le risque de pancréatite aigüe.
 
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