非甾体抗炎药联合用药预防经内镜逆行胰胆管造影术后胰腺炎的有效性分析——一项贝叶斯网状Meta分析
Efficacy of Combination of Nonsteroidal Anti-Inflammatory Drugs for Prevention of Pancreatitis after Endoscopic Retrograde Cholangiography—A Bayesian Network Meta-Analysis
DOI: 10.12677/ACM.2022.122185, PDF,    科研立项经费支持
作者: 杜 飞*, 师恒鑫*, 张永烜：青海大学研究生院，青海 西宁；青海大学附属医院肝胆胰外科，青海 西宁；于文昊, 孔繁玉, 王志鑫, 樊海宁, 任 利#：青海大学附属医院肝胆胰外科，青海 西宁
关键词: 经内镜逆行胰胆管造影术；吲哚美辛；双氯芬酸；非甾体抗炎药；Endoscopic Retrograde Cholangiopancreatography； Indomethacin； Diclofenac； Nonsteroidal Anti-Inflammatory Drugs
摘要: 目的：综合评价直肠100 mg非甾体类抗炎药(NSAIDs)及其组合用药预防经内镜逆行胰胆管造影术后胰腺炎的临床疗效。方法：检索PubMed、Cochrane Library、Embase数据库从建库至2021年7月7日所有关于胰腺炎、经内镜逆行胰胆管造影术(ERCP)、吲哚美辛、双氯芬酸的随机对照试验(RCTs)，根据纳入排除标准筛选文献并提取数据，采用Stata14MP、ADDIS进行数据分析。结果：纳入27项RCTs，术后胰腺炎患者13,496例，8种干预措施。网状Meta分析结果显示单用NSAIDs、高剂量NSAIDs、及NSAIDs组合用药与安慰剂相比在预防经内镜逆行胰腺胆管造影术后胰腺炎均具有显著差异，NSAIDs + 硝酸甘油是预防PEP最好的药物组合(OR = 0.20, 95% CI: 0.09, 0.41)，与单用NSAIDs比较，NSAIDs + 硝酸甘油也有明显预防效果(OR = 0.44, 95% CI: 0.21, 0.92)。概率排序结果显示NSAIDs + 硝酸甘油效果最优，高剂量NSAIDs疗效最弱。与安慰剂比较，单用NSAIDs (OR = 0.37, 95% CI: 0.14, 0.83)在中高风险人群中在预防PEP有效率方面差异有统计学意义。概率排序结果显示NSAIDs + 硝酸甘油在预防PEP有效率上成为最好干预措施的可能性最大(OR = 0.22, 95% CI: 0.03, 1.57)，其次为NSAIDs + 水合作用。结论：8项干预措施中，NSAIDs + 舌下硝酸甘油在总体以及高危人群中消除PEP的疗效明显优于其余药物；NSAIDs + 硝酸甘油、NSAIDs + 水合作用则可能是高危人群的最佳选择。
Abstract: Aim: To evaluate the clinical efficacy of 100 mg non-steroidal anti-inflammatory drugs (NSAIDs) and their combination in preventing pancreatitis after endoscopic retrograde cholangiopancreatography. Methods: All RCTs on pancreatitis, endoscopic retrograde cholangiopancreatography (ERCP), indomethacin and diclofenac from the establishment of PubMed, Cochrane Library and Embase databases to July 7, 2021 were searched. Literatures were screened and data were extracted according to inclusion and exclusion criteria. Stata14MP and ADDIS were used for data analysis. Result: A total of 27 Randomized controlled trial (RCTs) met inclusion criteria in the study, including eight interventions in 13,496 patients with post-ERCP pancreatitis (PEP). Results of a network meta-analysis showed significant differences in prevention of PEP between NSAIDs alone, high-dose NSAIDs, NSAIDs combination and placebo. NSAIDs + sublingual nitroglycerin was the best drug combination for PEP prevention (OR = 0.20, 95% CI: 0.09, 0.41), and there was also a statistically significant difference between NSAIDs + nitroglycerin and NSAIDS alone (OR = 0.44, 95% CI: 0.21, 0.92). Probability ranks showed that NSAIDs + sublingual nitroglycerin was the best, while high dose NSAID was the weakest. Compared with placebo, NSAIDs alone (OR = 0.43, 95% CI: 0.21, 0.81) and NSAIDs + hydration (OR = 0.31, 95% CI: 0.07, 0.95) had statistically significant differences in PEP prevention in middle and high-risk groups. Probability ranks showed that NSAIDs + sublingual nitroglycerin was the most likely intervention to prevent PEP effectiveness (OR = 0.22, 95% CI: 0.04, 1.12), followed by NSAIDs + hydration. Conclusion: Among the eight interventions, NSAIDs + nitroglycerin had a better efficacy in eliminating PEP than the other drugs in the general population; NSAIDs + hydration may be the best choice for high-risk groups, as may NSAIDs + nitroglycerin.
文章引用：杜飞, 师恒鑫, 张永烜, 于文昊, 孔繁玉, 王志鑫, 樊海宁, 任利. 非甾体抗炎药联合用药预防经内镜逆行胰胆管造影术后胰腺炎的有效性分析——一项贝叶斯网状Meta分析[J]. 临床医学进展, 2022, 12(2): 1267-1280. https://doi.org/10.12677/ACM.2022.122185

参考文献

[1] Kochar, B., Akshintala, V.S., Afghani, E., et al. (2015) Incidence, Severity, and Mortality of Post-ERCP Pancreatitis: A Systematic Review by Using Randomized, Controlled Trials. Gastrointestinal Endoscopy, 81, 143-149.e9. [Google Scholar] [CrossRef] [PubMed]
[2] Wang, A.Y., Strand, D.S. and Shami, V.M. (2016) Prevention of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis: Medications and Techniques. Clinical Gastroenterology and Hepatology, 14, 1521-1532.e3. [Google Scholar] [CrossRef] [PubMed]
[3] Cotton, P.B., Garrow, D.A., Gallagher, J. and Romagnuolo, J. (2009) Risk Factors for Complications after ERCP: A Multivariate Analysis of 11,497 Procedures over 12 Years. Gastrointestinal Endoscopy, 70, 80-88. [Google Scholar] [CrossRef] [PubMed]
[4] Ethridge, R.T., Chung, D.H., Slogoff, M., Ehlers, R.A., Hellmich, M.R., Rajaraman, S., et al. (2002) Cyclooxygenase-2 Gene Disruption Attenuatesthe Severity of Acute Pancreatitis and Pancreatitis-Associated Lunginjury. Gastroenterology, 123, 1311-1322. [Google Scholar] [CrossRef] [PubMed]
[5] ASGE Standards of Practice Committee, Chandrasekhara, V., Khashab, M.A., et al. (2017) Adverse Events Associated with ERCP. Gastrointestinal Endoscopy, 85, 32-47. [Google Scholar] [CrossRef] [PubMed]
[6] Dumonceau, J.M., Kapral, C., Aabakken, L., et al. (2020) ERCP-Related Adverse Events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy, 52, 127-149. [Google Scholar] [CrossRef] [PubMed]
[7] Serrano, J.P.R., de Moura, D.T.H., Bernardo, W.M., et al. (2019) Nonsteroidal Anti-Inflammatory Drugs versus Placebo for Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis: A Systematic Review and Meta-Analysis. Endoscopy International Open, 7, E477-E486. [Google Scholar] [CrossRef] [PubMed]
[8] Yang, J., Wang, W., Liu, C., Zhao, Y., Ren, M. and He, S. (2020) Rectal Nonsteroidal Anti-Inflammatory Drugs for Endoscopic Retrograde Cholangiopancreatography Postoperative Pancreatitis Prevention: A Network Meta-Analysis. Journal of Clinical Gastroenterology, 54, 305-313. [Google Scholar] [CrossRef] 
[9] Radadiya, D., Brahmbhatt, B., Reddy, C. and Devani, K. (2021) Efficacy of Combining Aggressive Hydration with Rectal Indomethacin in Preventing Post-ERCP Pancreatitis: A Systematic Review and Network Meta-Analysis. Journal of Clinical Gastroenterology. [Google Scholar] [CrossRef] 
[10] Hutton, B., Salanti, G., Caldwell, D.M., et al. (2015) The PRISMA Extension Statement for Reporting of Systematic Reviews Incorporating Network Meta-Analyses of Health Care Interventions: Checklist and Explanations. Annals of Internal Medicine, 162, 777-784. [Google Scholar] [CrossRef] 
[11] Sperna Weiland, C.J., Smeets, X.J.N.M., Kievit, W., et al. (2021) Aggressive Fluid Hydration plus Non-Steroidal Anti-Inflammatory Drugs versus Non-Steroidal Anti-Inflammatory Drugs Alone for Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis (FLUYT): A Multicentre, Open-Label, Randomised, Controlled Trial. The Lancet Gastroenterology and Hepatology, 6, 350-358. [Google Scholar] [CrossRef] 
[12] Hosseini, M., Shalchiantabrizi, P., Yektaroudy, K., Dadgarmoghaddam, M. and Salari, M. (2016) Prophylactic Effect of Rectal Indomethacin Administration, with and without Intravenous Hydration, on Development of Endoscopic Retrograde Cholangiopancreatography Pancreatitis Episodes: A Randomized Clinical Trial. Archives of Iranian Medicine, 19, 538-543.
[13] Lai, J.H., Hung, C.Y., Chu, C.H., et al. (2019) A Randomized Trial Comparing the Efficacy of Single-Dose and Double-Dose Administration of Rectal Indomethacin in Preventing Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis. Medicine (Baltimore), 98, e15742. [Google Scholar] [CrossRef] 
[14] Andrade-Dávila, V.F., Chávez-Tostado, M., Dávalos-Cobián, C., et al. (2015) Rectal Indomethacin versus Placebo to Reduce the Incidence of Pancreatitis after Endoscopic Retrograde Cholangiopancreatography: Results of a Controlled Clinical Trial. BMC Gastroenterology, 15, Article No. 85. [Google Scholar] [CrossRef] [PubMed]
[15] Döbrönte, Z., Szepes, Z., Izbéki, F., et al. (2014) Is Rectal Indomethacin Effective in Preventing of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis? World Journal of Gastroenterology, 20, 10151-10157. [Google Scholar] [CrossRef] [PubMed]
[16] Uçar, R., Biyik, M., Uçar, E., et al. (2016) Rectal or Intramuscular Diclofenac Reduces the Incidence of Pancreatitis after Endoscopic Retrograde Cholangiopancreatography. Turkish Journal of Medical Sciences, 46, 1059-1063. [Google Scholar] [CrossRef] [PubMed]
[17] Kamal, A., Akshintala, V.S., Talukdar, R., et al. (2019) A Randomized Trial of Topical Epinephrine and Rectal Indomethacin for Preventing Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis in High-Risk Patients. American Journal of Gastroenterology, 114, 339-347. [Google Scholar] [CrossRef] [PubMed]
[18] Wang, Y., Xu, B., Zhang, W., et al. (2020) Prophylactic Effect of Rectal Indomethacin plus Nitroglycerin Administration for Preventing Pancreatitis after Endoscopic Retrograde Cholangiopancreatography in Female Patients. Annals of Palliative Medicine, 9, 4029-4037. [Google Scholar] [CrossRef] [PubMed]
[19] Romano-Munive, A.F., García-Correa, J.J., García-Contreras, L.F., et al. (2021) Can Topical Epinephrine Application to the Papilla Prevent Pancreatitis after Endoscopic Retrograde Cholangiopancreatography? Results from a Double Blind, Multicentre, Placebo Controled, Randomised Clinical Trial. BMJ Open Gastroenterology, 8, e000562. [Google Scholar] [CrossRef] [PubMed]
[20] Elmunzer, B.J., Scheiman, J.M., Lehman, G.A., et al. (2012) A Randomized Trial of Rectal Indomethacin to Prevent Post-ERCP Pancreatitis. The New England Journal of Medicine, 366, 1414-1422. [Google Scholar] [CrossRef] 
[21] Norouzi, A., Ghasem Poori, E., Kaabe, S., et al. (2021) Effect of Adding Intravenous Somatostatin to Rectal Indomethacin on Post-Endoscopic Retrograde Cholangiopancreatography (ERCP) Pancreatitis in High-Risk Patients: A Double-Blind Randomized Placebo-Controlled Clinical Trial. Journal of Clinical Gastroenterology, 10, 1097. [Google Scholar] [CrossRef] 
[22] Fogel, E.L., Lehman, G.A., Tarnasky, P., et al. (2020) Rectal Indometacin Dose Escalation for Prevention of Pancreatitis after Endoscopic Retrograde Cholangiopancreatography in High-Risk Patients: A Double-Blind, Randomised Controlled Trial. The Lancet Gastroenterology and Hepatology, 5, 132-141. [Google Scholar] [CrossRef] 
[23] Hatami, B., Kashfi, S.M.H., Abbasinazari, M., et al. (2018) Epinephrine in the Prevention of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis: A Preliminary Study. Case Reports in Gastroenterology, 12, 125-136. [Google Scholar] [CrossRef] [PubMed]
[24] Sotoudehmanesh, R., Khatibian, M., Kolahdoozan, S., Ainechi, S., Malboosbaf, R. and Nouraie, M. (2007) Indomethacin May Reduce the Incidence and Severity of Acute Pancreatitis after ERCP. American Journal of Gastroenterology, 102, 978-983. [Google Scholar] [CrossRef] [PubMed]
[25] Katsinelos, P., Fasoulas, K., Paroutoglou, G., et al. (2012) Combination of Diclofenac plus Somatostatin in the Prevention of Post-ERCP Pancreatitis: A Randomized, Double-Blind, Placebo-Controlled Trial. Endoscopy, 44, 53-59. [Google Scholar] [CrossRef] [PubMed]
[26] Khoshbaten, M., Khorram, H., Madad, L., EhsaniArdakani, M.J., Farzin, H. and Zali, M.R. (2008) Role of Diclofenac in Reducing Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis. Journal of Gastroenterology and Hepatology, 23, e11-e16. [Google Scholar] [CrossRef] [PubMed]
[27] MontañoLoza, A., Rodríguez Lomelí, X., García Correa, J.E., et al. (2007) Efecto de la administración de indometacina rectal sobre los nivelesséricos de amilasaposteriores a colangiopancreatografíaretrógradaendoscópica y suimpactoen la aparición de episodios de pancreatitis secundaria [Effect of the Administration of Rectal Indomethacin on Amylase Serum Levels after Endoscopic Retrograde Cholangiopancreatography, and Its Impact on the Development of Secondary Pancreatitis Episodes]. Revista Espanola de Enfermedades Digestivas, 99, 330-336. [Google Scholar] [CrossRef] 
[28] Lua, G.W., Muthukaruppan, R. and Menon, J. (2015) Can Rectal Diclofenac Prevent Post Endoscopic Retrograde Cholangiopancreatography Pancreatitis? Digestive Diseases and Sciences, 60, 3118-3123. [Google Scholar] [CrossRef] [PubMed]
[29] Luo, H., Zhao, L., Leung, J., et al. (2016) Routine Pre-Procedural Rectal Indometacin versus Selective Post-Procedural Rectal Indometacin to Prevent Pancreatitis in Patients Undergoing Endoscopic Retrograde Cholangiopancreatography: A Multicentre, Single-Blinded, Randomised Controlled Trial. The Lancet, 387, 2293-2301. [Google Scholar] [CrossRef] 
[30] Luo, H., Wang, X., Zhang, R., et al. (2019) Rectal Indomethacin and Spraying of Duodenal Papilla with Epinephrine Increases Risk of Pancreatitis Following Endoscopic Retrograde Cholangiopancreatography. Clinical Gastroenterology and Hepatology, 17, 1597-1606.e5. [Google Scholar] [CrossRef] [PubMed]
[31] Mok, S.R.S., Ho, H.C., Shah, P., Patel, M., Gaughan, J.P. and Elfant, A.B. (2017) Lactated Ringer’s Solution in Combination with Rectal Indomethacin for Prevention of Post-ERCP Pancreatitis and Readmission: A Prospective Randomized, Double-Blinded, Placebo-Controlled Trial. Gastrointestinal Endoscopy, 85, 1005-1013. [Google Scholar] [CrossRef] [PubMed]
[32] Patai, Á., Solymosi, N. and Patai, Á.V. (2015) Effect of Rectal Indomethacin for Preventing Post-ERCP Pancreatitis Depends on Difficulties of Cannulation: Results from a Randomized Study with Sequential Biliary Intubation. Journal of Clinical Gastroenterology, 49, 429-437. [Google Scholar] [CrossRef] 
[33] Patil, S., Pandey, V., Pandav, N., Ingle, M., Phadke, A. and Sawant, P. (2016) Role of Rectal Diclofenac Suppository for Prevention and Its Impact on Severity of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis in High-Risk Patients. Gastroenterology Research, 9, 47-52. [Google Scholar] [CrossRef] [PubMed]
[34] Masjedizadeh, A., Fathizadeh, P. and Aghamohamadi, N. (2017) Comparative Effectiveness of Aggressive Intravenous Fluid Resuscitation with Lactated Ringer’s Solution and Rectal Indomethacin Therapy in the Prevention of Pancreatitis after Endoscopic Retrograde Cholangiopancreatography: A Double Blind Randomised Controlled Clinical Trial. Przegla̜d Gastroenterologiczny, 12, 271-276. [Google Scholar] [CrossRef] [PubMed]
[35] Sadeghi, A., Abbasinazari, M., AsadzadehAghdaei, H., et al. (2019) Does Melatonin Addition to Indomethacin Decrease Post Endoscopic Retrograde Cholangiopancreatography Pancreatitis? A Randomized Double-Blind Controlled Trial. European Journal of Gastroenterology & Hepatology, 31, 1350-1355. [Google Scholar] [CrossRef] 
[36] Sotoudehmanesh, R., Eloubeidi, M.A., Asgari, A.A., Farsinejad, M. and Khatibian, M. (2014) A Randomized Trial of Rectal Indomethacin and Sublingual Nitrates to Prevent Post-ERCP Pancreatitis. American Journal of Gastroenterology, 109, 903-909. [Google Scholar] [CrossRef] [PubMed]
[37] Murray, B., Carter, R., Imrie, C., Evans, S. and O’Suilleabhain, C. (2003) Diclofenac Reduces the Incidence of Acute Pancreatitis after Endoscopic Retrograde Cholangiopancreatography. Gastroenterology, 124, 1786-1791. [Google Scholar] [CrossRef] 
[38] Oh, H.C., Kang, H., Park, T.Y., Choi, G.J. and Lehman, G.A. (2021) Prevention of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis with a Combination of Pharmacological Agents Based on Rectal Non-Steroidal Anti-Inflammatory Drugs: A Systematic Review and Network Meta-Analysis. Journal of Gastroenterology and Hepatology, 36, 1403-1413. [Google Scholar] [CrossRef] [PubMed]
[39] Staritz, M., Poralla, T., Ewe, K. and Meyer zum Buschenfelde, K.H. (1985) Effect of Glyceryl Trinitrate on the Sphincter of Oddi Motility and Baseline Pressure. Gut, 26, 194-197. [Google Scholar] [CrossRef] [PubMed]
[40] Tenner, S., Baillie, J., DeWitt, J. and Vege, S.S. (2013) American College of Gastroenterology Guideline: Management of Acute Pancreatitis [Published Correction Appears in American Journal of Gastroenterology. 2014 Feb; 109(2): 302]. American Journal of Gastroenterology, 108, 1400-1416. [Google Scholar] [CrossRef] 
[41] Iqbal, U., Siddique, O., Khara, H.S., et al. (2020) Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis Prevention Using Topical Epinephrine: Systematic Review and Meta-Analysis. Endoscopy International Open, 8, E1061-E1067. [Google Scholar] [CrossRef] [PubMed]
[42] Aziz, M., Ghanim, M., Sheikh, T., et al. (2020) Rectal Indomethacin with Topical Epinephrine versus Indomethacin Alone for Preventing Post-ERCP Pancreatitis—A Systematic Review and Meta-Analysis. Pancreatology, 20, 356-361. [Google Scholar] [CrossRef] [PubMed]
[43] Gromski, M.A. and Fogel, E.L. (2019) End of the Road for Epinephrine Spraying of the Papilla to Prevent Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis? Clinical Gastroenterology and Hepatology, 17, 1446-1447. [Google Scholar] [CrossRef] [PubMed]
[44] Rana, S.S. (2020) High-Dose NSAIDs and Pancreatitis after ERCP: More Is Not Always Better. The Lancet Gastroenterology and Hepatology, 5, 95-97. [Google Scholar] [CrossRef] 
[45] Hajalikhani, M., Emami, M.H., Khodadoostan, M., Shavakhi, A., Rezaei, M. and Soluki, R. (2018) Combination of Diclofenac and Aggressive Hydration for the Prevention of Post-ERCP Pancreatitis. Gastroenterology and Hepatology from Bed to Bench, 11, 319-324.

为你推荐