SNFGE SNFGE
 
Thématique :
- Endoscopie/Imagerie
Originalité :
Réexamen
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Docteur Florian ROSTAIN
Coup de coeur :
 
 
Gastrointestinal Endoscopy
  2017/06  
 
  2017 Jun;85(6):1144-1156.e1.  
  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 a sufficient number of patients for correct evaluation of their efficacy. Our aim was to evaluate all prospective trials published in full text that studied the efficacy of diclofenac or indomethacin and were 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 = .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 = .0339). The efficacy of indomethacin compared with diclofenac was similar (P = .98). The efficacy of indomethacin or diclofenac did not differ according to timing (P = .99) or between patients with average-risk and high-risk for PEP (P = .6923). The effect of non-rectal administration of indomethacin or diclofenac was not significant (P = .1507), but the rectal route was very effective (P = .0005) with an 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 diclofenac or indomethacin before or closely after ERCP is inexpensive and safe and is recommended in every patient (without renal failure) undergoing ERCP. (Registration number: CRD42016042726, http://www.crd.york.ac.uk/prospero/.).

 

  
Question posée
 
Quelle est l’efficacité du Diclofénac et de l’Indométacine dans la prévention de la pancréatite aigüe post-CPRE ?
  
Question posée
 
Méta-analyse sur 4741 patients de 17 études qui montre l’effet protecteur du Diclofénac et de l’Indométacine avec un risque relatif de 0,60 (95% IC ;0,46-0,78; P = .0001). L’efficacité du Diclofénac et de l’Indométacine était comparable (p : 0,98). Il n’y avait pas de différence d’efficacité en fonction du moment d’administration ni en fonction du risque du patient, moyen ou élevé, de pancréatite aigüe post-CPRE. Il n’y avait pas d’efficacité de l’administration non rectale du Diclofénac et de l’Indométacine.
  
Commentaires

Encore une fois cette étude valide l’intérêt de l’administration rectale d’Indométacine ou de Diclofénac dans la prévention des pancréatites aigües post-CPRE.
 
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