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Background and Aims <p>Endoscopic retrograde cholangiopancreatography (ERCP) has significant diagnostic and therapeutic roles in pancreaticobiliary disorders. Post-ERCP pancreatitis (PEP) is the most common adverse event that can be encountered and affects 1% to&#xa0;9% of the average‐risk group and 11% to&#xa0;40% of the high-risk group. Several methods have been used to prevent PEP, including pancreatic duct (PD) stenting and pharmacological use, including indomethacin.</p> Methods <p>We conducted a systematic review of PubMed (MEDLINE), Scopus and Web of Science (WOS) databases until November 1, 2024, using relevant keywords. Only randomized clinical trials (RCTs) were included. The network meta-analysis is reported using odds ratios (ORs) with 95% confidence intervals (CIs) with a significance level &lt; 0.05. Rank probabilities were calculated using <i>p</i>-scores to rank treatments based on their effectiveness. All analyses were performed using R version 4.3.1 (2023–06-16 ucrt) with the netmeta package. The&#xa0;Grading of Recommendations,&#xa0;Assessment, Development and Evaluation (GRADE)&#xa0;assessment of the certainty of the evidence was performed.</p> Results <p>Of 1828 references, total 31 RCTs with 9050 participants were included in this meta-analysis. Compared to placebo, indomethacin (OR = 0.50, 95% CI = 0.39–0.64, <i>p</i> &lt; 0.001), PD stenting (OR = 0.33, 95% CI = 0.23–0.47, <i>p</i> &lt; 0.001) and indomethacin combined with PD stenting (OR = 0.36, 95% CI = 0.18–0.73, <i>p</i> = 0.005) were effective in reducing PEP. Sub-group analysis of high-risk patients revealed similar results, indomethacin (OR = 0.43, 95% CI = 0.31–0.61, <i>p</i> &lt; 0.001), PD stenting (OR = 0.32, 95% CI = 0.22–0.47, <i>p</i> &lt; 0.001) and indomethacin combined with PD stenting (OR = 0.32, 95% CI = 0.14–0.72, <i>p</i> = 0.006). Notably, indomethacin did not show significant effects in mild, moderate or severe PEP. Notably, indomethacin showed significant benefit in the prevention of moderate-severe PEP only.</p> Conclusions <p>The present network meta-analysis indicated that PD stenting seems to be the most effective in reducing PEP incidence among the examined treatments, particularly in high-risk patients, with inconsistent benefits of indomethacin in different PEP severities.</p> Graphical Abstract <p></p>

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The effectiveness of indomethacin and pancreatic duct stenting in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis: A systematic review and network meta-analysis

  • 期刊论文

  • 发表日期：

    2026年4月10日

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  • Ahmed Gamal Elshaar,
  • Ahmed Amir Samir,
  • Ahmed Samy Elgammal,
  • Roaa Abdulrhman Elaw,
  • Effa Afif Zain,
  • Omer Bin-Sahel,
  • Nada Ramadan Kamh,
  • Zahra Faried Farouq Serag,
  • Mohamed Diab Ramadan,
  • Magdy Mostafa Anber,
  • Zainab Osama,
  • Mohamed Elgohary,
  • Hossam Tharwat Ali

摘要

Background and Aims

Endoscopic retrograde cholangiopancreatography (ERCP) has significant diagnostic and therapeutic roles in pancreaticobiliary disorders. Post-ERCP pancreatitis (PEP) is the most common adverse event that can be encountered and affects 1% to 9% of the average‐risk group and 11% to 40% of the high-risk group. Several methods have been used to prevent PEP, including pancreatic duct (PD) stenting and pharmacological use, including indomethacin.

Methods

We conducted a systematic review of PubMed (MEDLINE), Scopus and Web of Science (WOS) databases until November 1, 2024, using relevant keywords. Only randomized clinical trials (RCTs) were included. The network meta-analysis is reported using odds ratios (ORs) with 95% confidence intervals (CIs) with a significance level < 0.05. Rank probabilities were calculated using p-scores to rank treatments based on their effectiveness. All analyses were performed using R version 4.3.1 (2023–06-16 ucrt) with the netmeta package. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) assessment of the certainty of the evidence was performed.

Results

Of 1828 references, total 31 RCTs with 9050 participants were included in this meta-analysis. Compared to placebo, indomethacin (OR = 0.50, 95% CI = 0.39–0.64, p < 0.001), PD stenting (OR = 0.33, 95% CI = 0.23–0.47, p < 0.001) and indomethacin combined with PD stenting (OR = 0.36, 95% CI = 0.18–0.73, p = 0.005) were effective in reducing PEP. Sub-group analysis of high-risk patients revealed similar results, indomethacin (OR = 0.43, 95% CI = 0.31–0.61, p < 0.001), PD stenting (OR = 0.32, 95% CI = 0.22–0.47, p < 0.001) and indomethacin combined with PD stenting (OR = 0.32, 95% CI = 0.14–0.72, p = 0.006). Notably, indomethacin did not show significant effects in mild, moderate or severe PEP. Notably, indomethacin showed significant benefit in the prevention of moderate-severe PEP only.

Conclusions

The present network meta-analysis indicated that PD stenting seems to be the most effective in reducing PEP incidence among the examined treatments, particularly in high-risk patients, with inconsistent benefits of indomethacin in different PEP severities.

Graphical Abstract