Pharmacological and procedural strategies to prevent post-ERCP pancreatitis: an umbrella review of meta-analyses of randomized controlled trials.
7 affiliations
- 1Department of Gastroenterology, National Clinical Research Center for Digestive Diseases, Changhai Hospital, Navy Medical University, Shanghai, China.
- 2Department of Gastroenterology, 72nd Group Army Hospital, Huzhou University, Huzhou, Zhejiang, China.
- 3Department of Gastroenterology, National Clinical Research Center for Digestive Diseases, Changhai Hospital, Navy Medical University, Shanghai, China. [email protected].
- 4National Key Laboratory of Immunity and Inflammation, Naval Medical University, Shanghai, China. [email protected].
- 5Department of Gastroenterology, National Clinical Research Center for Digestive Diseases, Changhai Hospital, Navy Medical University, Shanghai, China. [email protected].
- 6Department of Gastroenterology, National Clinical Research Center for Digestive Diseases, Changhai Hospital, Navy Medical University, Shanghai, China. [email protected].
- 7National Key Laboratory of Immunity and Inflammation, Naval Medical University, Shanghai, China. [email protected].
Abstract
Background
Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is the most common complication following ERCP, and its prevention remains a major concern for biliopancreatic endoscopists. This umbrella review aims to assess existing meta-analytic evidence on the effectiveness of pharmacological interventions (PIs) and procedural technical modifications (PTMs) in reducing the incidence and severity of PEP.Methods
We searched multiple databases to identify meta-analyses of randomized controlled trials (RCTs) that assessed the impacts of PIs or PTMs on the incidence and severity of PEP, from database inception to September 24, 2024. Evidence credibility was classified based on pre-specified criteria as: convincing (Class I), highly suggestive (Class II), suggestive (Class III), weak (Class IV), or non-significant evidence. Furthermore, the GRADE approach was employed to assess the quality of the evidence, categorizing it into four levels: high, moderate, low, and very low.Results
A review of 47 meta-analyses (137,391 participants; 25 on PIs, 22 on PTMs) identified five PIs with suggestive evidence for PEP prevention: indomethacin (odds ratio [OR] 0.52, 95% confidence interval [CI] 0.39-0.71), epinephrine (risk ratio [RR] 0.34, 95% CI 0.18-0.62), nafamostat mesylate (RR 0.50, 0.38-0.66), NSAIDs (RR 0.65, 0.52-0.81), and aggressive hydration (OR 0.40, 0.26-0.63). For PTMs, one intervention was classified as highly suggestive evidence: pancreatic stent placement (RR 0.37, 0.27-0.51), while guidewire-assisted cannulation was suggestive (RR 0.51, 0.36-0.72). For high-risk patients, both indomethacin (RR 0.46, 0.32-0.65) and pancreatic stent placement (RR 0.41, 0.30-0.56) were suggestive. No interventions exceeded Class III evidence for preventing moderate to severe PEP.Conclusions
Pancreatic stent placement and NSAIDs, such as indomethacin, have been confirmed as effective measures for PEP prevention in both unselected and high-risk patients.
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BibTeX
@article{jiang2026pharmacological,
title = {{Pharmacological and procedural strategies to prevent post-ERCP pancreatitis: an umbrella review of meta-analyses of randomized controlled trials.}},
author = {Mengruo Jiang and Liqi Sun and Lisi Peng and Deyu Zhang and Chao Liu and Lixiang Wang and Yuwei Sun and Zhendong Jin and Zhaoshen Li and Saif Ullah and Haojie Huang},
journal = {BMC medicine},
year = {2026},
month = aug,
doi = {10.1186/s12916-026-05115-0},
url = {https://europepmc.org/article/MED/42972564},
note = {CC BY},
}
RIS
TY - JOUR
TI - Pharmacological and procedural strategies to prevent post-ERCP pancreatitis: an umbrella review of meta-analyses of randomized controlled trials.
AU - Mengruo Jiang
AU - Liqi Sun
AU - Lisi Peng
AU - Deyu Zhang
AU - Chao Liu
AU - Lixiang Wang
AU - Yuwei Sun
AU - Zhendong Jin
AU - Zhaoshen Li
AU - Saif Ullah
AU - Haojie Huang
PY - 2026
DA - 2026/08/06
JO - BMC medicine
DO - 10.1186/s12916-026-05115-0
UR - https://europepmc.org/article/MED/42972564
AB - Background Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is the most common complication following ERCP, and its prevention remains a major concern for biliopancreatic endoscopists. This umbrella review aims to assess existing meta-analytic evidence on the effectiveness of pharmacological interventions (PIs) and procedural technical modifications (PTMs) in reducing the incidence and severity of PEP.Methods We searched multiple databases to identify meta-analyses of randomized controlled trials (RCTs) that assessed the impacts of PIs or PTMs on the incidence and severity of PEP, from database inception to September 24, 2024. Evidence credibility was classified based on pre-specified criteria as: convincing (Class I), highly suggestive (Class II), suggestive (Class III), weak (Class IV), or non-significant evidence. Furthermore, the GRADE approach was employed to assess the quality of the evidence, categorizing it into four levels: high, moderate, low, and very low.Results A review of 47 meta-analyses (137,391 participants; 25 on PIs, 22 on PTMs) identified five PIs with suggestive evidence for PEP prevention: indomethacin (odds ratio [OR] 0.52, 95% confidence interval [CI] 0.39-0.71), epinephrine (risk ratio [RR] 0.34, 95% CI 0.18-0.62), nafamostat mesylate (RR 0.50, 0.38-0.66), NSAIDs (RR 0.65, 0.52-0.81), and aggressive hydration (OR 0.40, 0.26-0.63). For PTMs, one intervention was classified as highly suggestive evidence: pancreatic stent placement (RR 0.37, 0.27-0.51), while guidewire-assisted cannulation was suggestive (RR 0.51, 0.36-0.72). For high-risk patients, both indomethacin (RR 0.46, 0.32-0.65) and pancreatic stent placement (RR 0.41, 0.30-0.56) were suggestive. No interventions exceeded Class III evidence for preventing moderate to severe PEP.Conclusions Pancreatic stent placement and NSAIDs, such as indomethacin, have been confirmed as effective measures for PEP prevention in both unselected and high-risk patients.
SN - 1741-7015
ER -