The combination of aggressive hydration and rectal non-steroidal anti-inflammatory drugs is not superior to rectal non-steroidal anti-inflammatory drugs alone in the prevention of pancreatitis after endoscopic retrograde cholangiopancreatography: a systematic review and meta-analysis

Background: endoscopic retrograde cholangiopancreatography (ERCP) can lead to many high-risk complications, of which acute pancreatitis is the most prevalent and serious one. Whether patients who receive prophylactic rectal non-steroidal anti-inflammatory drugs (NSAIDs) need to be combined with aggressive hydration remains controversial. Aim: The study was performed to determine whether there is collaborative facilitation between rectal NSAIDs and aggressive hydration in preventing post-ERCP pancreatitis (PEP). Methods: We searched all eligible studies on the preventive effects of active rehydration and NSAIDs on PEP from multiple databases including ClinicalTrials, PubMed, CQVIP, Embase, Web of Science, CNKI, Cochrane Library, and Wanfang Data. We performed a meta-analysis of the data related to the incidence of PEP as well as the serious cases including the incidence of severe PEP and mortality. Results: This meta-analysis included three published studies of randomized controlled trials with 1110 patients. Our results showed that additional aggressive hydration was not significantly effective for the prevention of PEP in patients who were already receiving rectal NSAIDs (odds ratio [OR], 0.43; 95% confidence interval [CI], 0.12-1.57; P=0.20). With regard to the prevention of serious cases, compared with rectal NSAIDs alone, aggressive fluid hydration combined with rectal NSAIDs did not reduce the morbidity of severe PEP (OR, 0.32; 95% CI, 0.10-1.08; P=0.07), nor did it reduce overall mortality (OR, 0.81; 95% CI, 0.28-2.36; P=0.70). Conclusion: Aggressive perioperative hydration combined with rectal NSAIDs was not superior to rectal NSAIDs along in the prevention of PEP.