In:
Alimentary Pharmacology & Therapeutics, Wiley, Vol. 38, No. 11-12 ( 2013-12), p. 1325-1337
Abstract:
The efficacy of many pharmacological agents for preventing post‐ ERCP pancreatitis ( PEP ) has been evaluated in randomised controlled trials ( RCT s), but it is unclear which agent(s) should be used in clinical practice. Network meta‐analyses of RCT s are used to simultaneously compare several agents to determine their relative efficacy and identify priority agents for comparison in future RCT s. Aim To evaluate pharmacological agents for the prevention of PEP by conducting a network meta‐analysis of RCT s. Methods We searched MEDLINE , EMBASE and Cochrane Library databases for RCT s that evaluated the efficacy of agents for preventing PEP . RCT s were simultaneously analysed using random‐effects network meta‐analysis under the Bayesian framework to identify the best agents. The efficacy of agents was ordered according to the probability of being ranked as any of the top three best performing agents. Results The network meta‐analysis included 99 RCT s evaluating 16 agents in 25 313 patients. Topical epinephrine (adrenaline) was the most efficacious agent with 85.9% probability of ranking among the top three agents, followed by nafamostat (51.4%), antibiotics (44.5%) and NSAID s (42.8%). However, in a sensitivity analysis including only rectal NSAID s, NSAID s moved from fourth rank to second (58.1%). Patients receiving topical epinephrine, compared with placebo, had a 75% reduced risk of PEP ( OR 0.25, 95% probability interval 0.06–0.66). Conclusions Topical epinephrine and rectal NSAID s are the most efficacious agents for preventing post‐ ERCP pancreatitis, based on existing RCT s. Combinations of these agents, which act on different steps in the pathogenesis of post‐ ERCP pancreatitis, should be evaluated in future trials.
Type of Medium:
Online Resource
ISSN:
0269-2813
,
1365-2036
DOI:
10.1111/apt.2013.38.issue-11pt12
Language:
English
Publisher:
Wiley
Publication Date:
2013
detail.hit.zdb_id:
2003094-0
SSG:
15,3
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