Four RCTs were included (n=912 patients). All of the trials were considered to be of reasonable quality. Two trials met all validity criteria, one trial met four criteria, and one trial met three criteria.
Rectal non-steroidal anti-inflammatory drugs (NSAIDs) were associated with a statistically significant reduction in post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) compared with placebo (RR 0.36, 95% CI 0.22 to 0.60; four RCTs; NNT 15). No significant heterogeneity was found.
Rectal NSAIDs were associated with a statistically significant reduction in moderate to severe pancreatitis compared with placebo, zero patients in the NSAID groups versus seven patients in the placebo control groups (RR 0.10, 95% CI 0.01 to 0.76; two RCTs; NNT 39).
None of the included trials reported any adverse effects associated with rectal NSAIDs.