Allopurinol for Prophylaxis Against Post ERCP Pancreatitis: A Metaanalysis of Randomized Controlled Trials
Notice bibliographique
Résumé
Purpose: Post-ERCP pancreatitis is a common complication after ERCP and contributes significantly to the morbidity and mortality of the procedure. A number of pharmacologic agents have been evaluated in an attempt to identify a strategy to reduce post ERCP pancreatitis with only mixed success. Based upon data from animal studies, allopurinol, a free radical scavenger, may prevent the cascade of inflammation in post ERCP pancreatitis. Since 1991, a number of large randomized controlled trials have been conducted to evaluate this effect with mixed results. We conducted a meta-analysis of the randomized controlled trials (RCTs) to evaluate the efficacy of prophylactic allopurinol in the prevention of post-ERCP pancreatitis. Methods: Medline, Cochrane Central Register of Controlled Trials & Database of Systemic Reviews, PubMed, and recent abstracts from major conference proceedings were searched through 11/10. RCTs comparing prophylactic allopurinol to placebo in patients undergoing ERCP were included. Standard forms were used to extract the data by two independent reviewers. The effects of prophylactic allopurinol were analyzed by calculating pooled estimates of post ERCP pancreatitis. Summary odds ratio was calculated using Comprehensive Meta-Analysis software. Publication bias was assessed by funnel plot. (Figure 1) Heterogeneity among studies was assessed by calculating 12 measures of inconsistency. Results: Seven RCT (N=2305) met the inclusion criteria. The studies were reported from the U.S., Canada, Mexico, Greece and Poland. Heterogenity was present and thus a random effect model was used for the analysis. Overall prophylactic allopurinol did not decrease the odds of developing post ERCP pancreatitis OR 0.70(95% CI: 0.36-1.36 p=0.29). (Figure 2) In subgroup analysis no differences were noted in the incidence of post ERCP pancreatitis with respect to the dosing of allopurinol. High dose allopurinol (1.2 g administered within 24hrs of the procedure) did not reduce the incidence of post ERCP pancreatitis OR 0.87 CI 0.61-1.24 p= 0.431), nor did low dose allopurinol (400 mg or less administered within 24hr of the procedure (OR 1.41, 95%CI 0.81-2.46)). The time of administration of allopurinol also did not have an effect on the rate of post ERCP pancreatitis. Loading the patient > 5 hrs prior to the procedure did not affect the rate of post-ERCP pancreatitis (OR 0.44, 95% CI: 0.14-1.39 p=0.16). Similarly drug dosing <5hrs prior to the procedure had no effect on the rate of pancreatitis. Publication bias was not present. Pooling of data from high quality studies (Jadad score >3) also did not reveal a reduction in the odds of pancreatitis. Conclusion: Prophylactic allopurinol does not prevent post ERCP pancreatitis.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,006 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,008 | 0,003 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».