Table 4 Subgroup analyses and sensitivity analyses of the efficacy of rectal NSAIDs versus no treatment in preventing post-ERCP pancreatitis.

From: Efficacy and safety of rectal nonsteroidal anti-inflammatory drugs for prophylaxis against post-ERCP pancreatitis: a systematic review and meta-analysis

Subgroup analyses

Sensitivity analyses

Subgroup

No. of patients (trials)

Test of relationship

Test of heterogeneity

No. of patients (trials)

Test of relationship

Test of heterogeneity

RR (95% CI)

P value

I2, %

P value

RR (95% CI)

P value

I2, %

P value

Total

6458 (16)

0.55 (0.42–0.71)

<0.01

41

0.04

6009 (15)

0.51 (0.41–0.65)

 <0.01

24

0.18

Type of NSAIDs

 Indomethacin

5543 (10)

0.58 (0.45–0.75)

<0.01

34

0.13

     

 Diclofenac

915 (6)

0.41 (0.19–0.90)

<0.01

55

0.05

764 (5)

0.32 (0.19–0.56)

<0.01

0

0.52

Timing of administration

 Pre-ERCP

4530 (9)

0.53 (0.42–0.67)

<0.01

0

0.43

     

 Post-ERCP

1239 (5)

0.46 (0.24–0.89)

<0.01

61

0.03

1088 (4)

0.39 (0.24–0.63)

<0.01

30

0.23

Population

 High risk

1135 (5)

0.41 (0.19–0.91)

0.03

66

0.02

984 (4)

0.31 (0.16–0.61)

<0.01

44

0.14

 Mixed risk†

2095 (7)

0.54 (0.33–0.88)

0.01

49

0.07

1646 (6)

0.46 (0.33–0.66)

<0.01

0

0.51

 Average risk‡

2884 (3)

0.60 (0.41–0.88)

<0.01

28

0.25

     

Mean age

 ≤60

2184 (9)

0.46 (0.31–0.69)

<0.01

39

0.11

     

 >60

4034 (6)

0.64 (0.43–0.96)

0.03

55

0.05

3585 (5)

0.55 (0.40–0.76)

<0.01

22

0.28

Pancreatic stent

 Yes

3702 (7)

0.56 (0.34, 0.91)

0.02

67

<0.01

     

 No

2516 (8)

0.56 (0.42, 0.75)

0.01

6

0.39

     
  1. NSAIDs, non-steroidal anti-inflammatory drugs; ERCP, endoscopic retrograde cholangiopancreatography; RR, relative risk; CI, confidence interval. Patients were considered as high-risk for post-ERCP pancreatitis if they met one or more of the major criteria: clinical suspicion of SOD, a history of post-ERCP pancreatitis, pancreatic sphincterotomy, precut sphincterotomy, ≥8 cannulation attempts, pneumatic dilatation of an intact biliary sphincter, or ampullectomy. Additionally, patients were also considered as high-risk for post-ERCP pancreatitis if they met at least two of the minor criteria: female less than 50 years, a history of recurrent pancreatitis (≥2 episodes), ≥3 injections of contrast agent into the pancreatic duct with ≥1 injection to the tail of the pancreas, excessive injection of contrast agent into the pancreatic duct resulting in opacification of pancreatic acini, or the acquisition of a cytologic specimen from the pancreatic duct with the use of a brush. Patients in the study by Khoshbaten et al. were also identified as high-risk for post-ERCP pancreatitis because they all underwent endoscopic retrograde pancreatography ± cholangiography due to extrahepatic cholestasis and/or impaired liver function tests. ‡Patients were considered as average-risk for post-ERCP pancreatitis if they did not meet above mentioned criteria for high-risk for post-ERCP pancreatitis. †Patients (e.g. unselected patients) were considered as mixed-risk for post-ERCP pancreatitis if the criteria of risk stratification of patients in included studies were not explicitly defined.
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