Sistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSPSERRANO, Juan Pablo RomanJUKEMURA, JoseROMANINI, Samuel GalanteAGUILAR, Paul Fernando GuamanCASTRO, Juliana Silveira Lima deTORRES, Isabela TrindadePULLA, Jose Andres SanchezNETO, Otavio MicelliTAGLIERI, EloyARDENGH, Jose Celso2021-02-182021-02-182020WORLD JOURNAL OF GASTROINTESTINAL ENDOSCOPY, v.12, n.11, 20201948-5190https://observatorio.fm.usp.br/handle/OPI/39483BACKGROUND Endoscopic retrograde cholangiopancreatography (ERCP) is the primary therapeutic procedure for the treatment of diseases affecting the biliary tree and pancreatic duct. Although the therapeutic success rate of ERCP is high, the procedure can cause complications, such as acute pancreatitis [post-ERCP pancreatitis (PEP)], bleeding and perforation. AIM To assess the efficacy of non-steroidal anti-inflammatory drugs (NSAIDs) in preventing PEP during follow-up. METHODS Databases such as MEDLINE, EMBASE and Cochrane Central Library were searched. Only randomized controlled trials (RCTs) comparing the efficacy of NSAIDs and placebo for the prevention of PEP were included. Outcomes evaluated included the incidence of PEP, severity of pancreatitis, route of administration, types, dose, and timing of administration of NSAIDs. RESULTS Twenty-six RCTs were considered eligible with a total of 8143 patients analyzed. Overall, 4020 patients used NSAIDs before ERCP and 4123 did not use NSAIDs (control group). Ultimately, 298 cases of post-ERCP acute pancreatitis were diagnosed in the NSAID group and 484 cases in the placebo group. The risk of PEP was lower in the NSAID group risk difference (RD): -0.04; 95% confidence interval (CI): -0.07 to - 0.03; number needed to treat (NNT), 25; P < 0.05. NSAID use effectively prevented mild pancreatitis compared to placebo use (2.5% vs 4.1%; 95%CI: -0.05 to -0.01; NNT, 33; P < 0.05), but information on moderate PEP and severe PEP could not be fully elucidated. Only rectal administration reduced the incidence of PEP with RD: -0.06; 95%CI: -0.08 to -0.04; NNT, 17; P < 0.05). Furthermore, only the use of diclofenac or indomethacin was effective in preventing PEP, at a dose of 100 mg, which must be administered before performing ERCP. CONCLUSION Rectal administration of diclofenac and indomethacin significantly reduced the risk of developing mild PEP. Additional RCTs are needed to compare the efficacy between NSAID routes of administration in preventing PEP.engopenAccessPancreatitisEndoscopic retrograde cholangiopancreatographyDiclofenacIndomethacinRectalrectal indomethacinercp pancreatitisintramuscular diclofenacrisk-factorsseverityefficacyreducetrialarticleCopyright BAISHIDENG PUBLISHING GROUP INC10.4253/wjge.v12.i11.469Gastroenterology & Hepatology