Nafamostat reduces the incidence of post-ERCP pancreatitis a systematic review and meta-analysis of randomized controlled trials /

Pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). As the management of pancreatitis is limited, clinical approaches focus on the prevention of post-ERCP pancreatitis (PEP). In theory, the serine protease inhibitor nafamostat can reduce circulating...

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Bibliographic Details
Main Authors: Horváth István László
Kleiner Dénes
Nagy Rita
Fehérvári Péter
Hankó Balázs
Hegyi Péter
Csupor Dezső
Format: Article
Published: 2024
Series:CLINICAL PHARMACOLOGY & THERAPEUTICS 115 No. 2
Subjects:
doi:10.1002/cpt.3118

mtmt:34413258
Online Access:http://publicatio.bibl.u-szeged.hu/29392
Description
Summary:Pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). As the management of pancreatitis is limited, clinical approaches focus on the prevention of post-ERCP pancreatitis (PEP). In theory, the serine protease inhibitor nafamostat can reduce circulating inflammatory mediators in pancreatitis. We aimed to investigate the effect of nafamostat in the prevention of PEP in this systematic review and meta-analysis. The protocol for this review was registered in PROSPERO (CRD42022367988). We systematically searched five databases without any filters on 26th September 2022. The eligible population was adult patients undergoing ERCP. We compared the PEP preventive effect of nafamostat to placebo. The main outcome was the occurrence of PEP. We calculated the pooled odds ratios (OR), mean differences (MD), and corresponding 95% confidence intervals (95%CI) and multilevel model. The risk of bias was assessed using the Rob2 tool. Seven randomized controlled trials involving 2,962 patients were eligible for inclusion. Nafamostat reduced the overall incidence rate of PEP [20 mg OR 0.50; 95%CI 0.30-0.82 and 50 mg 0.48; 95%CI 0.24-0.96]. However, the occurrence of mild PEP was significantly reduced only in the subgroup receiving 20 mg nafamostat [OR 0.49; 95%CI 0.31-0.77]. Overall, nafamostat therapy reduced moderate PEP in high-risk patients [OR 0.18; 95%CI 0.0.4-0.84] and mild PEP in low-risk patients [OR 0.32; 95%CI 0.17-0.61]. Nafamostat is an effective therapy in the prevention of mild post-ERCP pancreatitis. Further research is required to determine the cost-effectiveness of this therapy.
Physical Description:206-212
ISSN:0009-9236