Is early endoscopic retrograde cholangiopancreatography useful in the management of acute biliary pancreatitis? A meta-analysis of randomized controlled trials.
OBJECTIVE
To compare early endoscopic retrograde cholangiopancreatography with conservative management for the treatment of acute biliary pancreatitis: a meta-analysis of prospective randomized trials.


METHODS
Pertinent studies were selected from the Medline, Embase, and the Cochrane Library Databases, references from published articles and reviews. Conventional meta-analysis according to DerSimonian and Laird method was used for the pooling of the results. The rate difference (95% CI) and the number needed to treat were used as a measure of the therapeutic effect.


RESULTS
Five prospective randomized trials including 702 patients were selected. Overall complications and mortality rates were 31% and 6%, respectively. In predicted severe pancreatitis the pooled rate difference for complications in early endoscopic retrograde cholangiopancreatography was 38.5% (95% CI -53% to -23.9%); p < 0.0001; number needed to treat = 3. In predicted mild pancreatitis the pooled rate difference for complications in early endoscopic retrograde cholangiopancreatography was 1.8% (95% CI -5.6% to 9.3%); p = 0.6. No mortality was observed in predicted mild pancreatitis. In predicted severe pancreatitis the pooled rate difference for mortality in the early endoscopic retrograde cholangiopancreatography group was 4.3% (95% CI -16% to 7.5%); p < 0.24.


CONCLUSIONS
Early endoscopic retrograde cholangiopancreatography reduces pancreatits-related complications in patients with predicted severe pancreatitis although mortality rate is not affected. In predicted mild pancreatitis early endoscopic retrograde cholangiopancreatography has no advantage compared to conservative management.
Moretti
A
A
Gastroenterology Unit "San Filippo Neri" Hospital, Rome, Italy.
Papi
C
C
Aratari
A
A
Festa
V
V
Tanga
M
M
Koch
M
M
Capurso
L
L
D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D002761:Cholangitis / Q000150:complications; D006801:Humans; D019283:Pancreatitis, Acute Necrotizing / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome