Abstract

Background/Aims: Some meta-analyses suggest that pancreatic duct stents (PDS) placement and rectal nonsteroidal anti-inflammatory drugs (NSAIDs) can prevent post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP), but which is favorable is unclear. Thus, we conducted network analyses to compare treatment efficacies.

Materials and Methods: The Cochrane controlled trial registry, PubMed, China Biology Medicine disc (CBM disc) and Embase were reviewed, focusing on the randomized controlled trials (RCTs) of rectal NSAID and PDS prophylaxis throughout the PEP prophylaxis process On September 25, 2019. Reviewers extract data independently and randomly. The Cochrane handbook was used as a standard to assess migration risk, and intervention management was implemented in a systematic way. The rationality of the evidence is determined by means of grade evaluation, proposal formulation and evaluation, and the main output result is the effect of intervention.

Results: The RCTS was 32, and the total number of participants involved was 5311. Combined with the results of the standard meta-analysis, it was found that rectal NSAIDs and PDS implants significantly reduced the likelihood of PEP, PDS: OR= 0.34, 95% Confidence interval (CI) 0.24 to 0.49, I2=10.9%, Diclofenac (DIC): OR= 0.31 95% CI 0.16 to 0.59 I2=47.3%; indomethacin (ID): OR= 0.56 95% CI 0.41 to 0.76 I2=33.8%; Naproxen (NAP): OR= 0.38 95% CI 0.19 to 0.78. Network analysis of all trials demonstrated the quality of PDS OR 0.32 95% CI 0.21 to 0.48, DIC: OR 0.30 95% CI 0.18 to 0.49, ID: OR= 0.55 95% CI 0.39 to 0.77, NAP: OR= 0.55 95% CI 0.39 to 0.77. Network analysis ranking showed that PDS placement was the best way for preventing PEP, followed by NAP, ID, and DIC.

Conclusion: This evidence suggests that PDS placement is most effective in reducing PEP risk. However, rectal NSAIDs may be more ideal due to decreased costs.

Keywords: Rectal nonsteroidal anti-inflammatory drugs; Pancreatic duct stents; Post-endoscopic retrograde cholangiopancreatography pancreatitis; Network analysis