Saudi Journal of Gastroenterology
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ORIGINAL ARTICLE
Year : 2015  |  Volume : 21  |  Issue : 6  |  Page : 372-378

Prophylactic effect of somatostatin in preventing Post-ERCP pancreatitis: an updated meta-analysis


1 Department of Human Anatomy, College of Basic and Forensic Medicine, Sichuan University, Chengdu, Sichuan Province; Department of Geriatric Medicine and Gastroenterology, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital, Chengdu, Sichuan Province, China
2 Department of Human Anatomy, College of Basic and Forensic Medicine, Sichuan University, Chengdu, Sichuan Province, China
3 Department of Geriatric Medicine and Gastroenterology, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital, Chengdu, Sichuan Province, China

Correspondence Address:
Prof. Feng Shi
Department of Human Anatomy, College of Basic and Forensic Medicine, Sichuan University, No.17, Section 3, South Renmin Road, Chengdu, Sichuan
China
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Source of Support: None, Conflict of Interest: The authors declare that they have to no competing interest.


DOI: 10.4103/1319-3767.167187

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Background/Aims: Somatostatin is regarded as a prophylactic agent on post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP), but studies are still controversial. Materials and Methods: Electronic databases, including PubMed, EMBASE, the Cochrane library, and the Science Citation Index, were searched to retrieve relevant trials. In addition, meeting abstracts and the reference lists of retrieved articles were reviewed for further relevant studies. Results: Eleven randomized controlled trials (RCTs), enrolling a total of 2869 patients, were included in the meta-analysis. After data were pooled from somatostatin trials, PEP occurred in 8.36% of controls versus 5.62% of the treated group, with a slight significance [relative risk (RR) =0.58, 95% confidence interval (CI) 0.35–0.98, P = 0.04]. The funnel plot showed no asymmetry with a negative slope (P = 0.108). The meta-analysis produced negative results for short-term infusion of somatostatin (RR = 1.40, 95% CI 0.93–2.12, P = 0.11), whereas a bolus or long-term injection of the drug proved effective (RR = 0.25, 95% CI 0.13–0.47,P < 0.0001; RR = 0.44, 95% CI 0.27–0.71,P = 0.0008). Postprocedure hyperamylasemia and pain was also observed in the meta-analysis, the pooled RR was significant for reduced risk of postprocedure hyperamylasemia (RR = 0.72, 95%CI 0.63 to 0.81,P < 0.00001), but not for the pain (RR = 0.67, 95% CI 0.42 to 1.08,P= 0.10). Conclusion: The current meta-analysis on the prophylactic use of somatostatin in patients undergoing ERCP documents a lack of benefit when given as short-term infusion, but showed an advantage of a single bolus or long-term injection. The beneficial effect of somatostatin, in reducing the incidence of postprocedural hyperamylasemia seems of marginal clinical significance. However, more new confirmatory data are needed to settle residual doubts.


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