Meta-Analysis of early endoscopic retrograde cholangiopancreatography (ERCP) ± endoscopic sphincterotomy (ES) versus conservative management for gallstone pancreatitis (GSP)

Burstow, Matthew J., Yunus, Rossita M., Hossain, Md Belal, Khan, Shahjahan, Memon, Breda and Memon, Muhammed A. (2015) Meta-Analysis of early endoscopic retrograde cholangiopancreatography (ERCP) ± endoscopic sphincterotomy (ES) versus conservative management for gallstone pancreatitis (GSP). Surgical Laparoscopy, Endoscopy and Percutaneous Techniques, 25 3: 185-203. doi:10.1097/SLE.0000000000000142


Author Burstow, Matthew J.
Yunus, Rossita M.
Hossain, Md Belal
Khan, Shahjahan
Memon, Breda
Memon, Muhammed A.
Title Meta-Analysis of early endoscopic retrograde cholangiopancreatography (ERCP) ± endoscopic sphincterotomy (ES) versus conservative management for gallstone pancreatitis (GSP)
Journal name Surgical Laparoscopy, Endoscopy and Percutaneous Techniques   Check publisher's open access policy
ISSN 1534-4908
1530-4515
Publication date 2015-06
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1097/SLE.0000000000000142
Volume 25
Issue 3
Start page 185
End page 203
Total pages 19
Place of publication Philadelphia, PA United States
Publisher Lippincott Williams & Wilkins
Collection year 2016
Language eng
Formatted abstract
Context:  The utility of early endoscopic retrograde cholangiopancreatography (ERCP)±endoscopic sphincterotomy (ES) in the treatment of gallstone pancreatitis (GSP) is still contentious.

Objectives: The aim was to conduct a meta-analysis of randomized controlled trials (RCTs) investigating the treatment of GSP by early ERCP±ES versus conservative management and analyzing the patient outcomes.

Data Sources: A search of Medline, Embase, Science Citation Index, Current Contents, PubMed, and the Cochrane Database of Systematic Reviews identified all RCTs comparing early ERCP to conservative management in GSP published between January 1970 and January 2014. Search terms included “Endoscopic retrograde cholangiopancreatography (ERCP)”; “Endoscopic sphincterotomy”; “Gallstones”; “Bile duct stones”; “Gallstone pancreatitis”; “Biliary pancreatitis”; “Randomize/Randomised controlled trials”; “Conservative management/treatment”; “Human”; “English.”

Study Eligibility Criteria, Participants, and Interventions: Only prospective RCTs comparing early intervention (ie, between 24 and 72 h) with ERCP±ES versus conservative management in GSP were included.

Study Appraisal and Synthesis Methods: Data extraction and critical appraisal was carried out independently by 2 authors (M.J.B. and M.A.M.) using predefined data fields. Variables analyzed included severity of pancreatitis (mild or severe), overall mortality, overall complications which included pseudocyst formation, organ failure (renal, respiratory, and cardiac), abnormal coagulation, biliary sepsis, and development of pancreatic abscess/phlegmon. The quality of RCTs was assessed using Jadad’s scoring system. Random-effects model was used to calculate the outcomes of both binary and continuous data. Heterogeneity among the outcome variables of these trials was determined by the Cochran Q statistic and I2 index. The meta-analysis was prepared in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines.

Results: Eleven RCTs consisting of 1314 patients (conservative management=662, ERCP=652) were analyzed. There was a near significant decrease in mortality for ERCP group compared with conservatively managed patients with severe pancreatitis [odds ratio (OR) 0.45; 95% confidence interval (CI), 0.19, 1.09; P=0.08]. In patients with mild pancreatitis, mortality results were comparable for both groups (OR 0.66; 95% CI, 0.02, 28.75; P=0.83). Overall complications were significantly reduced in the ERCP group in severe pancreatic patients (OR 0.32; 95% CI, 0.17, 0.61; P=0.00). In those with mild disease, a strong trend to decreased complications in the ERCP group was seen, however, this was not significant (OR 0.67; 95% CI, 0.43, 1.03; P=0.06).

Conclusions: This meta-analysis demonstrates a significant decrease in complications in patients with severe GSP managed with early ERCP/ES compared with conservative management. As far as the mortality is concerned, no significant decrease was observed in mortality even in severe GSP patients treated with early ERCP/ES.
Keyword Endoscopic retrograde cholangiopancreatography (ERCP)
Endoscopic sphincterotomy (ES)
Meta-analysis
Randomized controlled trials (RCT)
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2016 Collection
School of Medicine Publications
 
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