Octreotide and Somatostatin as Prophylactic Agents Against Postendoscopic Retrograde Cholangiopancreatography Pancreatitis

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is a widely used procedure. Post-ERCP pancreatitis (PEP) remains a significant complication. This meta-analysis aimed to evaluate the efficacy of octreotide in reducing the incidence of PEP. Methods: A comprehensive review of randomized controlled trials (RCTs) was conducted across multiple databases to assess the impact of octreotide administration on post-ERCP outcomes, including acute pancreatitis (overall, mild, moderate, and severe), abdominal pain, and mortality. Pooled risk ratios (RR) were calculated using random-effects meta-analysis. Sensitivity analyses, Galbraith plots, Egger test, Begg funnel plots, and trim-and-fill correction were performed to assess the robustness of the findings, identify outliers, evaluate publication bias, and adjust for potentially missing studies. Results: The analysis included 21 RCTs for overall post-ERCP pancreatitis comprising 7229 patients, 15 RCTs for mild, moderate, and severe pancreatitis, 8 RCTs for abdominal pain, and 5 RCTs for mortality. Octreotide was associated with a significant reduction in the incidence of overall (RR: 0.63; 95% CI: 0.48-0.82) and moderate PEP (RR: 0.39; 95% CI: 0.22-0.67). However, no significant reduction was observed for mild and severe PEP, abdominal pain, or mortality. Evidence of publication bias was noted for overall and mild PEP, but trim-and-fill correction did not alter the significance of the overall pancreatitis result. Conclusion: Octreotide appears to be effective in reducing the risk of overall and moderate PEP. However, its impact on mild and severe PEP remains inconclusive. Further large-scale, high-quality RCTs are needed to refine clinical recommendations regarding its routine prophylactic use in ERCP.