医学
荟萃分析
随机对照试验
相对风险
胰腺炎
指南
禁忌症
内科学
重症监护医学
急性胰腺炎
置信区间
外科
替代医学
病理
作者
Katalin Márta,Noémi Gede,Zsolt Szakács,Margit Solymár,Péter Hegyi,Bálint Tél,Bálint Erőss,Áron Vincze,Marianna Arvanitakis,Ivo Boškoski,Marco J. Bruno,Péter Hegyi
出处
期刊:Pancreatology
[Elsevier]
日期:2021-10-01
卷期号:21 (7): 1247-1255
被引量:16
标识
DOI:10.1016/j.pan.2021.07.005
摘要
Post-ERCP pancreatitis (PEP) is a life-threatening complication. Given the lack of a causative treatment for pancreatitis, it is of vital importance to minimize this risk of PEP. Multi-target preventive therapy may be the best choice for PEP prevention as disease development is multifactorial. We aimed to assess the efficacy of a combination of indomethacin and hydration – type and amount – for PEP prevention via a network meta-analysis. Through a systematic search in three databases, we searched all randomized controlled trials involving hydration and indomethacin and ranked the PEP preventive efficacy with a Bayesian network meta-analysis using the PRISMA for Network Meta-Analyses (PRISMA-NMA) guideline. The RoB2 tool was used for risk of bias assessment, surface under the cumulative ranking curve (SUCRA) for ranking and PROSPERO for the study protocol [reg. no. CRD42018112698]. We used risk ratios (RR) for dichotomous data with 95% credible intervals (95% CrI). The quantitative analysis included 7559 patients from 24 randomized controlled trials. Based on the SUCRA values, a combination of lactated Ringer's and indomethacin is more effective than single therapy with a 94% certainty. The percent relative risk ratios estimate preventive efficacy 70–99% higher for combinations than single therapies. Aggressive hydration with indomethacin (SUCRA 100%) is also significantly more effective than all other interventions (percent relative effect 94.3–98.1%). A one-hit-on-each-target therapeutic approach is recommended in PEP prevention with an easily accessible combination of indomethacin and aggressive hydration for all average and high-risk patients without contraindication.
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