P4290 - Comparative Effectiveness and Safety of Prophylactic Drugs in Preventing Clinically Relevant Postoperative Pancreatic Fistula After Pancreatic Resection: A Network Meta-Analysis of RCTs

Ashesh Das, MBBS¹, Harshawardhan Dhanraj Ramteke, MBBS², Rakhshanda Khan, MBBS³, Gaurav Sharma, MBBS⁴, Ramiz RAMIZ. Ahmed, MBBS⁵, Sumit Sharma, ⁶, Anwar Syed, MBBS⁷, Shrouk Ramadan, ⁸, Hakim Wazir, MBBS⁹, Abhishek Palaniappan, MBBS¹⁰, Jaya Sai Mupparaju, MBBS¹¹, Nitish Naidu Boya, MBBS¹², Okasha Tahir, MBBS¹³, Hanumanthu Kavya. Tejaswini, MBBS¹⁴, Nanditha Nandakishor, MBBS¹⁵, Mohammed Isa, MBBS¹⁶, Navaneethan Adityaraj Shivalingam Vanaraj Nadar, MBBS¹⁷, Basheer Ahmed, MBBS¹⁶, Rehan Rafiuddin Gulam, MBBS¹⁸, Ivin Thomas. Jolly, MBBBS², Manish Madanlal. Juneja, DM, MD, MBBS¹⁹
1KPC Medical College and Hospital , Kolkata, India, Kolkata, West Bengal, India; 2Anhui Medical University, Hefei, Hefei, Anhui, China; 3Ayaan institute of medical sciences, Moinabad, Telangana, India; 4Jaipur national university institute for medical sciences and research center, Jaipur, Rajasthan, India; 5Government Medical College and Hospital, Kolkata, Howrah, West Bengal, India; 6Odessa national medical unversity, Ghaziabad, Uttar Pradesh, India; 7Bhaskar Medical College, Chicago, IL; 8Ain Shams University, Cairo, Al Qahirah, Egypt; 9Gajju Khan Medical College,Swabi Pakistan Medicine department, Shahmansor, Swabi, North-West Frontier, Pakistan; 10KMCH medical college, Coimbatore, Salem, Tamil Nadu, India; 11NRI Medical College, Vijayawada, Andhra Pradesh, India; 12Bhaskar Medical College, Hyderabad, Telangana, India; 13Bacha khan medical college, Mardan, Islamabad, Pakistan; 14GSL medical college, Rajahmundry, Andhra Pradesh, India; 15JJM Medical College, Davangere, Bangalore, Karnataka, India; 16Ayaan Institute of Medical Sciences Teaching Hospital and Research Centre, Ranga Reddy, Telangana, India; 17Coimbatore Medical College Hospital, Coimbatore, Tamil Nadu, India; 18Ayaan Institute of Medical Sciences, Hyderabad, Telangana, India; 19Rhythm Heart and Critical Care, Nagpur, Nagpur, Maharashtra, India

Introduction: Clinically relevant postoperative pancreatic fistula (POPF) is a serious complication after pancreatic surgery. Multiple prophylactic drugs, including somatostatin analogs and steroids, are used to prevent POPF, but their comparative effectiveness and safety are uncertain. This network meta-analysis evaluates these treatments to identify the best options for prevention.

Methods: We systematically searched five databases to identify relevant randomized controlled trials (RCTs). Screening of studies was conducted using Covidence. Network meta-analysis was performed with the Netmeta package in R, and visualizations such as forest plots, along with supplementary analyses, were generated using Stata 18.0. The quality and risk of bias of included studies were assessed with the ROBS 2.0 tool.

Results: A total of 2,782 records were screened, with 17 studies meeting inclusion criteria, comprising 2,850 patients (1,411 treatment; 1,439 control). Patient distribution included 80 hydrocortisone, 369 octreotide, 410 pasireotide, 1,376 placebo, and 137 somatostatin recipients. Somatostatin showed the greatest reduction in overall postoperative pancreatic fistula (POPF) risk (OR 0.40; 95% CI, 0.16–0.97), followed by octreotide (OR 0.55; 95% CI, 0.37–0.82), hydrocortisone (OR 0.91; 95% CI, 0.29–2.83), while pasireotide demonstrated no significant benefit (OR 1.06; 95% CI, 0.55–2.05). SUCRA rankings confirmed somatostatin as the most effective, followed by octreotide and hydrocortisone, with placebo and pasireotide least effective. Additionally, somatostatin achieved the highest improvement in quality of life (QOL) among the interventions. Postoperative morbidity (RR 0.17; 95% CI, 0.10–0.44), 30-day mortality (RR 0.18; 95% CI, 0.07–0.36), and respiratory adverse events (RR 0.26; 95% CI, 0.19–0.47) were significantly reduced. These findings support the superior efficacy and safety of somatostatin and select analogs for preventing clinically relevant POPF after pancreatic resection.

Discussion: This network meta-analysis demonstrates that somatostatin and octreotide are the most effective prophylactic agents for reducing clinically relevant POPF after pancreatic resection, with somatostatin also providing the greatest quality of life benefit. These findings highlight the importance of selecting appropriate pharmacologic prophylaxis to improve postoperative outcomes and reduce morbidity and mortality.


Figure: The Summary representation of Prophylactic Drugs in Preventing Clinically Relevant Postoperative Pancreatic Fistula After Pancreatic Resection

Disclosures:
Ashesh Das indicated no relevant financial relationships.
Harshawardhan Dhanraj Ramteke indicated no relevant financial relationships.
Rakhshanda Khan indicated no relevant financial relationships.
Gaurav Sharma indicated no relevant financial relationships.
Ramiz Ahmed indicated no relevant financial relationships.
Sumit Sharma indicated no relevant financial relationships.
Anwar Syed indicated no relevant financial relationships.
Shrouk Ramadan indicated no relevant financial relationships.
Hakim Wazir indicated no relevant financial relationships.
Abhishek Palaniappan indicated no relevant financial relationships.
Jaya Sai Mupparaju indicated no relevant financial relationships.
Nitish Naidu Boya indicated no relevant financial relationships.
Okasha Tahir indicated no relevant financial relationships.
Hanumanthu Tejaswini indicated no relevant financial relationships.
Nanditha Nandakishor indicated no relevant financial relationships.
Mohammed Isa indicated no relevant financial relationships.
Navaneethan Adityaraj Shivalingam Vanaraj Nadar indicated no relevant financial relationships.
Basheer Ahmed indicated no relevant financial relationships.
Rehan Rafiuddin Gulam indicated no relevant financial relationships.
Ivin Jolly indicated no relevant financial relationships.
Manish Juneja indicated no relevant financial relationships.

Ashesh Das, MBBS¹, Harshawardhan Dhanraj Ramteke, MBBS², Rakhshanda Khan, MBBS³, Gaurav Sharma, MBBS⁴, Ramiz RAMIZ. Ahmed, MBBS⁵, Sumit Sharma, ⁶, Anwar Syed, MBBS⁷, Shrouk Ramadan, ⁸, Hakim Wazir, MBBS⁹, Abhishek Palaniappan, MBBS¹⁰, Jaya Sai Mupparaju, MBBS¹¹, Nitish Naidu Boya, MBBS¹², Okasha Tahir, MBBS¹³, Hanumanthu Kavya. Tejaswini, MBBS¹⁴, Nanditha Nandakishor, MBBS¹⁵, Mohammed Isa, MBBS¹⁶, Navaneethan Adityaraj Shivalingam Vanaraj Nadar, MBBS¹⁷, Basheer Ahmed, MBBS¹⁶, Rehan Rafiuddin Gulam, MBBS¹⁸, Ivin Thomas. Jolly, MBBBS², Manish Madanlal. Juneja, DM, MD, MBBS¹⁹. P4290 - Comparative Effectiveness and Safety of Prophylactic Drugs in Preventing Clinically Relevant Postoperative Pancreatic Fistula After Pancreatic Resection: A Network Meta-Analysis of RCTs, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.