Bottom line: Rectal NSAIDs are effective in preventing PEP.
Summary: Two meta-analyses provide the evidence.
Gut. 2008 Sep;57(9):1262-7.
Meta-analysis of four RCTs with 912 patients total. Pooled relative risk for PEP after prophylactic administration of NSAIDs of .36 (95% CI 0.22 to .60). Pts who received NSAIDs during the periprocedural period were 64% less likely to develop PEP and 90% less likely to develop moderate to severe PEP. Pooled NNT to prevent one episode of PEP: 15.
Clin Gastroenterol Hepatol. 2013 Jul;11(7):778-83.
Meta-analysis of 29 studies (22 of pancreatic duct (PD) stents and 7 of NSAIDs) concluded that rectal NSAIDs alone are more effective in preventing PED than PD stents alone. High-quality RCTs are needed to compare the interventions and affirm the conclusion.
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