Efficacy of hydration combined with rectal non-steroidal anti-inflammatory drugs (NSAIDs) versus NSAIDs alone for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND

The most prevalent complication of endoscopic retrograde cholangiopancreatography (ERCP) is post-ERCP acute pancreatitis (PEP). Both hydration and rectal non-steroidal anti-inflammatory drugs (NSAIDs) can effectively prevent PEP; however, there is currently no consensus on whether combination therapy is more effective than either intervention alone.

METHODS

The PubMed/Medline, Web of Science, Embase and Cochrane Library (last updated in October 2024) were systematically searched to identify and screen potentially eligible studies, from which relevant data were extracted, Review Manager 5.3 was used for meta-analysis to determine the preventive utility of hydration + rectal NSAIDs for PEP.

RESULTS

Five studies comprising 1344 patients were included in the meta-analysis. Patients were divided into 2 groups (hydration + NSAIDs [n=654] and NSAIDs alone [n=690], a total of 107 patients experienced PEP (hydration + NSAIDs [n=40] and NSAIDs alone [n=67]). Results of meta-analysis revealed no significant difference in the incidence of PEP between patients receiving rectal NSAIDs + hydration versus rectal NSAIDs alone (odds ratio [OR] 0.57, 95% confidence interval [CI] 0.25-1.30; P = 0.18).

CONCLUSION

Compared with rectal NSAIDs alone, the combination of hydration and rectal NSAIDs does not appear to have a significant synergistic effect in the prevention of PEP. However, considering their distinct mechanisms of action and the observed reduction in PEP incidence with combined use, we believe that this approach still holds considerable clinical relevance. Further large-scale studies are needed to validate these findings.