title: Incidence, severity, and mortality of post-ERCP pancreatitis: a systematic review by using randomized, controlled trials.
abstract: BACKGROUND
  Data regarding the incidence and severity of post-ERCP pancreatitis (PEP) are primarily from nonrandomized studies.
  
  
  OBJECTIVE
  To determine the incidence, severity, and mortality of PEP from a systematic review of the placebo or no-stent arms of randomized, controlled trials (RCTs).
  
  
  METHODS
  MEDLINE, EMBASE, and Cochrane databases were searched to identify RCTs evaluating the efficacy of drugs and/or pancreatic stents to prevent PEP.
  
  
  METHODS
  Systematic review of patients enrolled in RCTs evaluating agents for PEP prophylaxis.
  
  
  METHODS
  Patients in the placebo or no-stent arms of the RCTs
  
  
  METHODS
  ERCP.
  
  
  METHODS
  Incidence, severity, and mortality of PEP.
  
  
  RESULTS
  There were 108 RCTs with 13,296 patients in the placebo or no-stent arms. Overall, the PEP incidence was 9.7% and the mortality rate was 0.7%. Severity of PEP was reported for 8857 patients: 5.7%, 2.6%, and 0.5% of cases were mild, moderate, and severe, respectively. The incidence of PEP in 2345 high-risk patients was 14.7% and the severity of PEP was mild, moderate, and severe in 8.6%, 3.9%, and 0.8%, respectively, with a 0.2% mortality rate. The incidence of PEP was 13% in North American RCTs compared with 8.4% in European and 9.9% in Asian RCTs. ERCPs conducted before and after 2000 had a PEP incidence of 7.7% and 10%, respectively.
  
  
  CONCLUSIONS
  Difference in PEP risk among patients in the included RCTs.
  
  
  CONCLUSIONS
  The incidence of PEP and severe PEP is similar in high-risk patients and the overall cohort. Discrepancies in the incidence of PEP across geographic regions require further study.
authors.affiliation: Department of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Bharati
authors.initials: B
authors.lastname: Kochar
authors.affiliation: Division of Gastroenterology, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Venkata S
authors.initials: VS
authors.lastname: Akshintala
authors.affiliation: Division of Gastroenterology, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Elham
authors.initials: E
authors.lastname: Afghani
authors.affiliation: Division of Gastroenterology, University of Michigan Medical Center, Ann Arbor, Michigan, USA.
authors.forename: B Joseph
authors.initials: BJ
authors.lastname: Elmunzer
authors.affiliation: Division of Gastroenterology, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Kim
authors.affiliation: Division of Gastroenterology, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Lennon
authors.affiliation: Division of Gastroenterology, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Mouen A
authors.initials: MA
authors.lastname: Khashab
authors.affiliation: Division of Gastroenterology, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Anthony N
authors.initials: AN
authors.lastname: Kalloo
authors.affiliation: Division of Gastroenterology, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Vikesh K
authors.initials: VK
authors.lastname: Singh
mesh_terms: D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D010195:Pancreatitis / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D015607:Stents / Q000009:adverse effects*