Are rectal NSAIDs effective in preventing post-ERCP pancreatitis (PEP)?

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.


About Lisa

I have been a Clinical Informationist (aka Medical Librarian) for Emory University since September 2013. Prior to that, I was a Medical Librarian for Lincoln Memorial University (LMU) from March 2007 to August 2013 and served its DeBusk College of Osteopathic Medicine, Caylor School of Nursing, and allied health programs. From January 2002 - March 2007, I served the Medical Assisting (MA), Occupational Therapy Assistant, Physical Therapy Assistant, Radiologic Technologist, and Nursing programs at South College in Knoxville, Tennessee. I graduated from The University of Tennessee School of Information Sciences with a Master of Science degree in December 2000.
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