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The following is a summary of “Systematic review and meta-analysis: no evidence that low-dose non-steroidal anti-inflammatory drugs (NSAIDs) reduce the risk of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP),” published in the February 2025 issue of the BMC Gastroenterology by Li et al.
The use of nonsteroidal anti-inflammatory drugs (NSAIDs) as a prophylactic intervention for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis has been widely studied, with high-dose NSAIDs demonstrating significant effectiveness. However, there is ongoing debate regarding the potential efficacy of lower NSAID doses, with some studies suggesting a protective effect. To address these uncertainties, this study systematically evaluates the impact of NSAIDs on post-ERCP pancreatitis prevention through a comprehensive meta-analysis, incorporating propensity score-matched studies to minimize selection bias. Keywords such as “ERCP,” “NSAIDs,” and “propensity score matching” were utilized, leading to the inclusion of three relevant studies encompassing 857 patients, 417 who received NSAIDs prior to ERCP and 440 in the control group.
Statistical analyses were performed using RevMan 5.3, applying a random-effects model to account for potential study variability. The meta-analysis results indicated no statistically significant difference between the NSAID and control groups, with an odds ratio (OR) of 0.82 (95% confidence interval: 0.45–1.49, P = 0.74) and no observed heterogeneity (I2 = 0%). Sensitivity analyses confirmed the robustness of the findings, demonstrating minimal impact when any single study was excluded. These results challenge previous reports suggesting that NSAIDs effectively reduce the incidence of post-ERCP pancreatitis, particularly when lower doses are administered. The findings raise concerns regarding the consistency and reliability of prior research, highlighting the potential limitations of current dosing strategies. The observed lack of efficacy may be attributed to insufficient NSAID dosages or variations in study design, warranting further investigation. Given the absence of definitive evidence supporting NSAID use in this context, large-scale, well-designed clinical trials are essential to clarify optimal dosing regimens, establish standardized treatment guidelines, and improve patient outcomes.
Source: bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-025-03690-9
