A330 PREVENTION OF POST-ERCP PANCREATITIS: DO PROTEASE INHIBITORS HAVE A ROLE?
Bibliographic record
Abstract
Acute pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). Rectal Indomethacin and prophylactic pancreatic stent placement have been shown to be effective for the prevention of post-ERCP pancreatitis. However, there remains considerable controversy regarding the usefulness of protease inhibitors (PIs) in preventing PEP. This systematic review of randomized controlled trials (RCTs) aims to compare PIs with other pharmacological agents and/or placebo. CENTRAL (the Cochrane library), MEDLINE, EMBASE, and CINAHL databases, and major conference proceedings from DDW, UEGW and ACG up to July 2017 were searched for RCTs examining PIs against other pharmacological agents and/or placebo. Study selection, data extraction and quality assessment were conducted independently by two authors. The primary outcome was PEP. Secondary outcomes included severity of PEP and other ERCP-related complications such as bleeding, perforation, cholangitis, cholecystitis and mortality. The outcomes were pooled into a meta-analysis using risk ratios (RR) with 95% confidence intervals (CI; Mandel-Haenszel method; random effects model). Heterogeneity was assessed by Chi2 test (P<0.15) and I2 test (> 25%). The risk of bias was assessed using the Cochrane Risk of Bias Assessment Tool. 23 RCTs (7091 patients) comparing four different types of PIs with placebo were included in this review. Overall, there was a significant reduction in the risk of post-ERCP pancreatitis with PIs compared with placebo (RR 0.56, 95% CI 0.44–0.73, I2 = 33%). Among the seven studies that compared Ulinastatin with placebo, the incidence of PEP was 3.9% in the PI group vs. 8.3% in the placebo group (RR 0.48; 95% CI 0.30–0.76; I2 = 0%). Among the seven studies that compared Nafamostat with placebo, the incidence of PEP was 3.8% in the PI group vs. 8.2% in the control group (RR 0.43; 95% CI 0.31–0.59, I2=0%). There was no statistically significant difference found in the comparison between Gabexate versus placebo (RR 0.68; 95% CI 0.41–1.12; I2 = 48%). In the one study that assessed Aprotinin versus placebo, there was no statistically significant difference (RR 1.38, 95% CI 0.66–2.86). Overall, the risks of bleeding (1.5%), perforation (0.2%), cholangitis (1.2%) and mortality (0.3%) appeared to be low. Protease inhibitors, specifically Nafamostat and Ulinastatin, are effective in preventing PEP. Further studies are needed to assess the optimal dose, timing and duration of PI, as well as the cost-effectiveness in different subgroups of patients. As well, the role of PIs along with prophylactic PD stent placement and rectal NSAIDs will need to be further elucidated in RCTs. Post-ERCP Pancreatitis in PIs versus Placebo None
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.026 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.007 | 0.007 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.004 | 0.004 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.005 | 0.003 |
| Insufficient payload (model declined to judge) | 0.010 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".