SynthesisPancreas2026
Rectal Nonsteroidal Anti-Inflammatory Drugs, Aggressive Hydration With Lactated Ringer's Solution, Somatostatin or Combinations for Prophylaxis Post-ERCP Acute Pancreatitis: A Network Meta-Analysis.
Synthesis in Pancreas, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
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Authors and funding
2 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
aimTo evaluate the clinical efficacy of Rectal nonsteroidal anti-inflammatory drugs (NSAIDs), Aggressive hydration with Lactated Ringer's solution (ALRS), somatostatin, or combinations in preventing pancreatitis and hyperamylasemia after endoscopic retrograde cholangiopancreatography (ERCP).
methodsA systematic review was conducted following PRISMA guidelines, searching all studies from the PubMed, Embase, Ovid, Cochrane library and Google Scholar. Stata software 14.0 and RevMan 5.4 were used for statistical analysis. Outcomes assessed included the incidence of post-ERCP pancreatitis (PEP), post-ERCP hyperamylasemia (PEHA), bleeding, and perforation.
resultsForty-one trials were identified and included in the network meta-analysis, involving 15,627 patients. Somatostatin (OR=0.49, 95% CI= 0.34-0.71), rectal indomethacin (OR=0.63, 95% CI= 0.44-0.9), and rectal indomethacin + somatostatin (OR=0.31, 95% CI= 0.14-0.69) were all more efficacious than placebo in preventing PEP. The combination of rectal indomethacin and somatostatin was the best preventive strategy for PEP, with a surface under the cumulative ranking curves (SUCRA) probability of 80.9%. In terms of PEHA, somatostatin (OR=0.18, 95% CI= 0.1-0.33), rectal indomethacin (OR=0.68, 95% CI= 0.55-0.84), and rectal indomethacin + somatostatin (OR=0.45, 95% CI= 0.28-0.73) were all more efficacious than placebo in preventing PEHA. On the basis of the SUCRA, rectal indomethacin + somatostatin (100%) was found to be the most efficacious modality for the prevention of PEHA. In addition, rectal indomethacin + somatostatin showed the lowest risk of bleeding (77.5%) and perforation (93.8%).
conclusionsThe combination of rectal indomethacin and somatostatin was most effective for preventing PEP and PEHA, which has the lowest risk of bleeding and perforation. Given the limited number of studies directly assessing this combination, SUCRA rankings do not always imply clinically meaningful superiority, more large-scale clinical RCTs need to be included in the future to confirm this conclusion.
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