Pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography
(ERCP). As the management of pancreatitis is limited, clinical approaches focus on
the prevention of post-ERCP pancreatitis (PEP). In theory, the serine protease inhibitor
nafamostat can reduce circulating inflammatory mediators in pancreatitis. We aimed
to investigate the effect of nafamostat in the prevention of PEP in this systematic
review and meta-analysis. The protocol for this review was registered in PROSPERO
(CRD42022367988). We systematically searched five databases without any filters on
26th September 2022. The eligible population was adult patients undergoing ERCP. We
compared the PEP preventive effect of nafamostat to placebo. The main outcome was
the occurrence of PEP. We calculated the pooled odds ratios (OR), mean differences
(MD), and corresponding 95% confidence intervals (95%CI) and multilevel model. The
risk of bias was assessed using the Rob2 tool. Seven randomized controlled trials
involving 2,962 patients were eligible for inclusion. Nafamostat reduced the overall
incidence rate of PEP [20 mg OR 0.50; 95%CI 0.30-0.82 and 50 mg 0.48; 95%CI 0.24-0.96].
However, the occurrence of mild PEP was significantly reduced only in the subgroup
receiving 20 mg nafamostat [OR 0.49; 95%CI 0.31-0.77]. Overall, nafamostat therapy
reduced moderate PEP in high-risk patients [OR 0.18; 95%CI 0.0.4-0.84] and mild PEP
in low-risk patients [OR 0.32; 95%CI 0.17-0.61]. Nafamostat is an effective therapy
in the prevention of mild post-ERCP pancreatitis. Further research is required to
determine the cost-effectiveness of this therapy.
