Jin Ho Choi1, Sang Hyub Lee1, Nam Young Park1, Joo Seong Kim1, Min Woo Lee1, In Rae Cho1, Woo Hyun Paik1, Ji Kon Ryu1, Yong-Tae Kim1

1Department of Internal Medicine, Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea

Background/Aims: In this network meta-analysis, we compared the efficacy of prophylactic strategies to decrease the risk of postendoscopic retrograde cholangiopancreatography pancreatitis (PEP) among patients with risk factors.

Methods: We did a systematic review to identify randomized controlled trials from PUBMED, EMBASE, and the Cochrane database through December 2019. We used network meta-analysis to compare the rates of PEP among patients who had received prophylactic treatment as follows: No prophylaxis or placebo (control), prophylaxis with nonsteroidal anti-inflammatory drugs (PN), prophylaxis with drugs other than nonsteroidal anti-inflammatory drugs (PNN), prophylactic pancreatic stent insertion (PS), and prophylaxis with pancreatic stent and pharmacologic prevention (PSP). We selected those studies that included patients with risk factors for PEP.

Results: We identified 16 trials, comprising 3,678 participants, and compared five preventive strategies. When we used a frequentist network meta-analysis with a random effect model, the PN (Odds ratio [OR], 0.48; with a 95% confidence interval [CI], 0.25 - 0.93), the PS (OR, 0.47; 95% CI, 0.24 - 0.92), and the PSP (OR, 0.41; 95% CI, 0.21 - 0.82) were associated with a reduced risk of PEP as compared to the control, except for the PNN (OR, 1.12; 95% CI, 0.62 - 2.01).

Conclusion: The results of this network meta-analysis suggest that PSP, PS and PN have similar levels of preventive effects as compared to control management in patients with risk factors for PEP. It is difficult to confirm the significant additive effects of PS or any pharmacologic prevention.

Keywords: Post-ERCP pancreatitis, Prophylaxis, NSAIDs, Pancreatic stent, Pharmacologic preventions