Gabexate in the prophylaxis of post-ERCP pancreatitis: a meta-analysis of randomized controlled trials

Background: Acute pancreatitis is a common complication of endoscopic retrograde cholangiopancreatography and the benefit of its pharmacological treatment is unclear. Although prophylactic use of gabexate for the reduction of pancreatic injury after ERCP has been evaluated, the discrepancy about gabexate's beneficial effect on pancreatic injury still exists. This study aimed to evaluate the effectiveness and safety of gabexate in the prophylaxis of post-endoscopic retrograde cholangiopancreatography pancreatitis ( PEP). Methods: We employed the method recommended by the Cochrane Collaboration to perform a meta-analysis of randomized controlled trials (RCTs) of gabexate in the prevention of post-ERCP pancreatitis ( PEP) including three RCTs conducted in Italy and one in China. Results: All of the four RCTs were of high quality. When the RCTs were analyzed, odds ratios ( OR) for gabexate mesilate were 0.67 [95% CI ( 0.31 similar to 1.47), p = 0.32] for PEP, 3.78 [ 95% CI (0.62 similar to 22.98), p = 0.15] for severe PEP, 0.68 [ 95% CI (0.19 similar to 2.43), p = 0.56] for the case-fatality of PEP, 0.88 [ 95% CI ( 0.72 similar to 1.07), p = 0.20] for post-ERCP hyperamylasemia, 0.69 [ 95% CI (0.39 similar to 1.21), p = 0.19] for post-ERCP abdominal pain, thus indicating no beneficial effects of gabexate on acute pancreatitis, the death rate of PEP, hyperamylasemia and abdominal pain. No evidence of publication bias was found. Conclusion: Gabexate mesilate can not prevent the pancreatic injury after ERCP. It is not recommended for the use of gabexate mesilate in the prophylaxis of PEP.