Nafamostat Mesylate in the Prevention of Post-endoscopic Retrograde Cholangiography Pancreatitis: A Meta-analysis

Previous evidence from observational studies showed that Nafamostat mesylate (NM) was effective in post-ERCP pancreatitis prevention. We aimed to assess full-text prospective studies on the role of NM in post-ERCP pancreatitis prevention. We searched the PubMed, Medline, and Google Scholar databases for relevant articles during the period from 2009 to November 2020 and updated on March 2022. No restriction regarding the language of publication. The keywords nafamostat mesylate, post-ERCP pancreatitis, prevention, and role were used. A total of 113 studies were identified through the database search, and eight studies (all were published in Asia) met the inclusion criteria for the systematic review. There were five control trials (four randomized and one comparative) and three case-control studies, (3186 patients included. In the present meta-analysis, seven studies concluded the benefit of nafamostat mesylate in the prevention of post-ERCP pancreatitis, and one showed no benefit. The overall effect was highly significant, odd ratio, 0.51, 95%CI=0.38-0.70, P-value=0.0001, heterogeneity=0.17%, P-value for heterogeneity=0.30, I2=17%. Nafamostat mesylate might be effective in post-ERCP pancreatitis prevention. Larger randomize multi-center studies investigating the effectiveness in combination with other preventive measures are needed.