Document Detail


Early endoscopic retrograde cholangiopancreatography versus conservative management in acute biliary pancreatitis without cholangitis: a meta-analysis of randomized trials.
MedLine Citation:
PMID:  18216529     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Early endoscopic retrograde cholangiopancreatography (ERCP) should be performed in all patients with acute biliary pancreatitis (ABP) and coexisting acute cholangitis. In patients without cholangitis and predicted mild ABP it is generally accepted that early ERCP should not be performed. Nevertheless, there is a controversy regarding the role of early ERCP in the treatment of patients with predicted severe ABP without cholangitis. We reviewed randomized trials on early ERCP versus conservative management in patients with ABP without acute cholangitis. METHODS: Relevant publications in 3 electronic databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials) were systematically reviewed and meta-analyzed. RESULTS: Seven randomized trials on ERCP in acute pancreatitis were found, of which 3 including a total of 450 patients (230 in the invasive arm and 220 in the control arm) qualified for a meta-analysis according to predefined criteria. In all patients with ABP (predicted mild and severe), early ERCP was associated with a nonsignificant reduction in overall complications [risk ratio (RR) 0.76; 95% confidence interval (CI) 0.41-1.04; P = 0.38] and a nonsignificant increase in mortality (RR 1.13; 95% CI 0.23-5.63; P = 0.88). Subgroup analysis based on predicted severity did not affect these outcomes (overall complications: predicted mild: RR 0.86; 95% CI 0.62-1.19; P = 0.36; predicted severe: RR 0.82; 95% CI 0.32-2.10; P = 0.68; mortality: predicted mild: RR 1.90; 95% CI 0.25-14.55; P = 0.53; predicted severe: RR 1.28; 95% CI 0.20-8.06; P = 0.80). CONCLUSION: In this meta-analysis, early ERCP in patients with predicted mild and predicted severe ABP without acute cholangitis did not lead to a significant reduction in the risk of overall complications and mortality.
Authors:
Maxim S Petrov; Hjalmar C van Santvoort; Marc G H Besselink; Geert J M G van der Heijden; Karel J van Erpecum; Hein G Gooszen
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Review    
Journal Detail:
Title:  Annals of surgery     Volume:  247     ISSN:  0003-4932     ISO Abbreviation:  Ann. Surg.     Publication Date:  2008 Feb 
Date Detail:
Created Date:  2008-01-24     Completed Date:  2008-03-13     Revised Date:  2009-02-10    
Medline Journal Info:
Nlm Unique ID:  0372354     Medline TA:  Ann Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  250-7     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, Nizhny Novgorod State Medical Academy, Nizhny Novgorod, Russia. max.petrov@gmail.com
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MeSH Terms
Descriptor/Qualifier:
Cholangiopancreatography, Endoscopic Retrograde / methods*
Cholangitis / complications
Humans
Pancreatitis, Acute Necrotizing / complications,  mortality,  surgery*
Randomized Controlled Trials as Topic*
Survival Rate / trends
Treatment Outcome
Comments/Corrections
Comment In:
Ann Surg. 2008 Aug;248(2):345-6; author reply 346-7   [PMID:  18650652 ]
Nat Clin Pract Gastroenterol Hepatol. 2008 Sep;5(9):484-5   [PMID:  18628734 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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