TY - JOUR
T1 - Evaluation of pharmacologic prevention of pancreatitis after endoscopic retrograde cholangiopancreatography
T2 - A systematic review
AU - Kubiliun, Nisa M.
AU - Adams, Megan A.
AU - Akshintala, Venkata S.
AU - Conte, Marisa L.
AU - Cote, Gregory A.
AU - Cotton, Peter B.
AU - Dumonceau, Jean Marc
AU - Elta, Grace H.
AU - Fogel, Evan L.
AU - Freeman, Martin L.
AU - Lehman, Glen A.
AU - Naveed, Mariam
AU - Romagnuolo, Joseph
AU - Scheiman, James M.
AU - Sherman, Stuart
AU - Singh, Vikesh K.
AU - Elmunzer, B. Joseph
N1 - Publisher Copyright:
© 2015 AGA Institute.
PY - 2015/7/1
Y1 - 2015/7/1
N2 - Background & Aims: There is controversy over the efficacy of pharmacologic agents for preventing pancreatitis after endoscopic retrograde cholangiopancreatography (PEP). We performed a systematic review of PEP pharmacoprevention to evaluate safety and efficacy. Methods: We performed a systematic search of the literature for randomized controlled trials (RCTs) and meta-analyses of PEP pharmacoprevention through February 2014. After identifying relevant studies, 2 reviewers each extracted information on study characteristics, clinical outcomes, and risk of bias. A research classification scale was developed to identify pharmacologic agents ready for clinical use, agents for which a confirmatory RCT should be considered a high priority, agents for which exploratory studies are still necessary, and agents for which additional research should be of low priority. Clinical and research recommendations for each agent were made by consensus after considering research classification results and other important factors such as magnitude of benefit, safety, availability, and cost. Results: After screening 851 citations and 263 potentially relevant articles, 2 reviewers identified 85 RCTs and 28 meta-analyses that were eligible. On the basis of these studies, rectal nonsteroidal anti-inflammatory drugs were found to be appropriate for clinical use, especially for high-risk cases. Sublingual nitroglycerin, bolus-administered somatostatin, and nafamostat were found to be promising agents for which confirmatory research is warranted. Additional research was found to be required to justify confirmatory RCTs for topical epinephrine, aggressive intravenous fluids, gabexate, ulinastatin, secretin, and antibiotics. Conclusions: On the basis of a systematic review, NSAIDs are appropriate for use in prevention of PEP, especially for high-risk cases. Additional research is necessary to clarify the role of other pharmacologic agents. These findings could inform future research and guide clinical decision-making and policy.
AB - Background & Aims: There is controversy over the efficacy of pharmacologic agents for preventing pancreatitis after endoscopic retrograde cholangiopancreatography (PEP). We performed a systematic review of PEP pharmacoprevention to evaluate safety and efficacy. Methods: We performed a systematic search of the literature for randomized controlled trials (RCTs) and meta-analyses of PEP pharmacoprevention through February 2014. After identifying relevant studies, 2 reviewers each extracted information on study characteristics, clinical outcomes, and risk of bias. A research classification scale was developed to identify pharmacologic agents ready for clinical use, agents for which a confirmatory RCT should be considered a high priority, agents for which exploratory studies are still necessary, and agents for which additional research should be of low priority. Clinical and research recommendations for each agent were made by consensus after considering research classification results and other important factors such as magnitude of benefit, safety, availability, and cost. Results: After screening 851 citations and 263 potentially relevant articles, 2 reviewers identified 85 RCTs and 28 meta-analyses that were eligible. On the basis of these studies, rectal nonsteroidal anti-inflammatory drugs were found to be appropriate for clinical use, especially for high-risk cases. Sublingual nitroglycerin, bolus-administered somatostatin, and nafamostat were found to be promising agents for which confirmatory research is warranted. Additional research was found to be required to justify confirmatory RCTs for topical epinephrine, aggressive intravenous fluids, gabexate, ulinastatin, secretin, and antibiotics. Conclusions: On the basis of a systematic review, NSAIDs are appropriate for use in prevention of PEP, especially for high-risk cases. Additional research is necessary to clarify the role of other pharmacologic agents. These findings could inform future research and guide clinical decision-making and policy.
KW - Drug
KW - Outcome
KW - Pancreas
KW - Post-ERCP
UR - http://www.scopus.com/inward/record.url?scp=84931570282&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84931570282&partnerID=8YFLogxK
U2 - 10.1016/j.cgh.2014.11.038
DO - 10.1016/j.cgh.2014.11.038
M3 - Article
C2 - 25579870
AN - SCOPUS:84931570282
SN - 1542-3565
VL - 13
SP - 1231
EP - 1239
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
IS - 7
ER -