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Medline ® Abstract for Reference 122

of 'Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis'

Nafamostat mesilate for prevention of post-ERCP pancreatitis: a meta-analysis of prospective, randomized, controlled trials.
Yu G, Li S, Wan R, Wang X, Hu G
Pancreas. 2015;44(4):561.
OBJECTIVES: We aimed to evaluate the efficacy of nafamostat on the prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP).
METHODS: Medline, Embase, Cochrane Central Register of Controlled Trials, and Web of Science were searched until April 18, 2014.
RESULTS: Seven randomized controlled trials and 2956 patients met the search criteria. When compared with nonnafamostat, the incidence of PEP was reduced to 53% in the patients who received nafamostat (risk ratio [RR], 0.47; 95% confidence interval [CI], 0.34-0.63). Further analyses were conducted based on the different risk classifications (n = 641 in patients with high risks: RR, 0.54; 95% CI, 0.30-0.96 and n = 944 with low risks: RR, 0.31; 95% CI, 0.17-0.56), PEP severities (n = 1654: RR, 0.38; 95% CI, 0.25-0.59 for mild; RR, 0.37; 95% CI, 0.15-0.96 for moderate; RR, 0.92; 95% CI, 0.13-6.38 for severe), and nafamostat doses (n = 1902: RR, 0.42; 95% CI, 0.28-0.63 for 20 mg; n = 1150: RR, 0.40; 95% CI, 0.25-0.63 for 50 mg). However, there was no reduction of the incidence of post-ERCP hyperamylasemia (n = 1585; 95% CI, 0.68-1.45) or cannulation difficulty (n = 1585; 95% CI, 0.91-1.23).
CONCLUSIONS: Pooled analyses from current randomized controlled trials support the effectiveness of nafamostat for prophylaxis of PEP.
From the *Department of Gastroenterology, Shanghai First People's Hospital, Shanghai Jiaotong University School of Medicine; and†Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.