Prophylactic NSAIDs effectively prevent pancreatitis after ERCP, according to recently published findings.

Prophylactic non-steroidal anti-inflammatory drugs (NSAIDs) effectively prevent pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP), according to findings published in the September issue of the journal Gut.

Dr. BJ Elmunzer of the University of Michigan, Ann Arbor, and colleagues write that because "prospective clinical trials evaluating NSAIDs in preventing post-ERCP pancreatitis have yielded inconclusive results," they conducted a meta-analysis of prospective, randomized controlled trials reported in Medline, Embase, meeting abstracts, and bibliographies.

Four studies of rectally administered NSAIDs given to prevent post-ERCP pancreatitis, involving a total of 912 patients, met the inclusion criteria. The pooled relative risk (RR) for post-ERCP pancreatitis after NSAIDs administration was 0.36. Patients treated with NSAIDs in the periprocedural period were 64 per cent less likely to develop pancreatitis, according to the authors, and 90 per cent less likely to develop moderate to severe pancreatitis.

The pooled number of patients needed to treat with NSAIDs to prevent one episode of pancreatitis was 15. No treatment-related adverse events were reported in any of the studies.

"Widespread prophylactic administration of these agents may result in substantial reduction in the incidence of post-ERCP pancreatitis, translating into major economic benefit," Dr. Elmunzer and colleagues conclude. "Further studies are necessary to refine our estimate of the substantial protection from severe pancreatitis conferred by NSAIDs and to establish whether these medications act synergistically with other prophylactic interventions, such as pancreatic stenting."

Gut 2008;57:1262-1267