Octreotide and Somatostatin as Prophylactic Agents Against Postendoscopic Retrograde Cholangiopancreatography Pancreatitis: An Updated Comprehensive Systematic Review and Meta-Analysis.

BACKGROUND

Endoscopic retrograde cholangiopancreatography (ERCP) is a widely used procedure. Post-ERCP pancreatitis (PEP) remains a significant complication. This meta-analysis aimed to evaluate the efficacy of octreotide in reducing the incidence of PEP.

METHODS

A comprehensive review of randomized controlled trials (RCTs) was conducted across multiple databases to assess the impact of octreotide administration on post-ERCP outcomes, including acute pancreatitis (overall, mild, moderate, and severe), abdominal pain, and mortality. Pooled risk ratios (RR) were calculated using random-effects meta-analysis. Sensitivity analyses, Galbraith plots, Egger test, Begg funnel plots, and trim-and-fill correction were performed to assess the robustness of the findings, identify outliers, evaluate publication bias, and adjust for potentially missing studies.

RESULTS

The analysis included 21 RCTs for overall post-ERCP pancreatitis comprising 7229 patients, 15 RCTs for mild, moderate, and severe pancreatitis, 8 RCTs for abdominal pain, and 5 RCTs for mortality. Octreotide was associated with a significant reduction in the incidence of overall (RR: 0.63; 95% CI: 0.48-0.82) and moderate PEP (RR: 0.39; 95% CI: 0.22-0.67). However, no significant reduction was observed for mild and severe PEP, abdominal pain, or mortality. Evidence of publication bias was noted for overall and mild PEP, but trim-and-fill correction did not alter the significance of the overall pancreatitis result.

CONCLUSION

Octreotide appears to be effective in reducing the risk of overall and moderate PEP. However, its impact on mild and severe PEP remains inconclusive. Further large-scale, high-quality RCTs are needed to refine clinical recommendations regarding its routine prophylactic use in ERCP.