Aggressive hydration plus Nonsteroidal Anti-Inflammatory Drugs versus Nonsteroidal Anti-Inflammatory Drugs alone for preventing post-ERCP pancreatitis: a meta-analysis
In brief
Pooled pancreatitis rates were 2.8% with added hydration vs 7.6% with NSAIDs alone
Across eight randomized trials involving 1,903 adults undergoing ERCP, pooled post-procedure pancreatitis rates were lower with aggressive hydration plus NSAIDs than with NSAIDs alone. However, analyses designed to account for small samples remained inconclusive, and the evidence does not establish that adding hydration is superior; larger trials are still needed.
- Journal
- Endoscopy (Q1)
- Published
- 7 October 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Daniele Balducci, Marco Valvano, Michele Montori, Antonio Vinci, Francesco Martini, Maria Eva Argenziano, et al.
- PMID
- 42843802
- DOI
- 10.1055/a-2974-3642
Why clinicians should know about it
- Picked for Gastroenterology (top studies of the week, 11 October 2026): Aggressive hydration + NSAIDs vs NSAIDs alone for PEP
Abstract
BACKGROUND & AIMS: Post-ERCP pancreatitis (PEP) remains the most frequent adverse event after ERCP. Although rectal NSAIDs and aggressive intravenous hydration are guideline-endorsed, the incremental benefit of adding hydration to NSAIDs is uncertain. We performed a meta-analysis of randomized controlled trials (RCTs) comparing NSAIDs plus aggressive hydration versus NSAIDs alone for PEP prevention. METHODS: A systematic search in MEDLINE, Scopus, and Cochrane Library databases was performed for RCTs comparing NSAIDs plus aggressive hydration versus NSAIDs alone in adults undergoing ERCP. For the primary outcome a random-effects meta-analysis was conducted to estimate the PEP pooled risk ratios (RRs) with 95% CIs. Supplementary analyses included pooled arm-specific PEP incidence, sensitivity analyses for few trials and sparse events, and trial sequential analysis (TSA). RESULTS: Eight RCTs with a total of 1,903 patients were included. The pooled arm-specific incidence of PEP was 2.8% (95% CI 0.4%-6.7%) with NSAIDs plus aggressive hydration and 7.6% (95% CI 5.2%-10.4%) with NSAIDs alone.. The DerSimonian-Laird random-effects analysis suggested a directionally favorable but statistically inconclusive estimate with combination prophylaxis (RR 0.66, 95% CI 0.40-1.08; I²=18%),whereas the pooled risk difference was -3.8% (95% CI -6.3 to -1.4). . The REML/Hartung-Knapp analysis was also inconclusive (RR 0.73, 95% CI 0.45-1.18). Trial sequential analysis showed that the required information size (RIS) had not been reached. CONCLUSIONS: Compared with NSAIDs alone, the addition of aggressive hydration resulted in a directionally lower but statistically inconclusive relative risk of PEP. Although the pooled risk difference favored combination therapy, the small-sample-robust and trial-sequential analyses remained inconclusive. The available evidence therefore does not establish superiority.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.