[Meta-analysis: somatostatin for prophylaxis against post endoscopic retrograde cholangiopancreatography...

Objective: To evaluate the efficacy of somatostatin in preventing pancreatitis after endoscopic retrograde cholangiopancreatography(ERCP). Methods: A standardized comprehensive literature search was performed by Cochrane library, PubMed, OVID, Springer Linker, Science Direct, EBSCO. Randomized controlled studies on the prevention of pancreatitis after ERCP before Octorber 2015 were enrolled in the study and were analyzed by 2 independent reviewers. Random-effects model(REM) or fixed-effects model (FEM) was applied to calculate pooled estimates of drug efficacy depending on the outcomes. The bias risk of the included studies was evaluated by Cochrane Handbook 5.1. All data were analyzed by the RevMan 5.3 software. Results: Twelve studies, including 3 268 participants, met the inclusion criteria. The results of subgroup analysis showed that high-dose somatostatin infused over 12 h could significantly decrease the incidence of pancreatitis after ERCP(11.3% vs. 4.9%, OR=0.34, 95% CI: 0.20-0.58, P=0.000), however, low-dose or bolus injection proved ineffective in reducing rate of pancreatitis after ERCP (8.5% vs. 6.4%, OR=1.37, 95% CI: 0.89-2.12, P=0.150; 4.9% vs. 9.3%, OR=0.39, 95% CI: 0.14-1.04, P=0.060). Results of intention-to-treat analysis showed that high-dose somatostatin infused over 12 h could significantly decrease the incidence of pancreatitis after ERCP (OR=0.45, 0.49; 95% CI: 0.25-0.81, 0.27-0.91; P=0.008, 0.020). Conclusions: High-dose somatostatin could prevent post-ERCP pancreatitis. Low-dose nor bolus injection somatostatin produced no significant effect in reducing pancreatic injury.