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

Burstow, Matthew J. and Yunus, Rossita M. and Hossain, Md Belal and Khan, Shahjahan and 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). pp. 185-203. ISSN 1530-4515

Abstract

OBJECTIVES: The aim was to conduct a meta-analysis of 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 gallstone pancreatitis published between January 1970 and January 2014.
STUDY ELIGIBILITY CRITERIA, PARTICIPANTS & INTERVENTIONS: Only prospective RCTs comparing early intervention (i.e. between 24 and 72 hours) with ERCP ± ES versus conservative management in GSP were included.
STUDY APPRASIAL AND SYNTHESIS METHODS: Variables analysed included overall mortality, overall morbidity, severity of pancreatitis (mild or severe), pseudocyst formation, organ failure (renal, respiratory and cardiac), abnormal coagulation, biliary sepsis and development of pancreatic abscess/phlegmon.
RESULTS: Eleven RCTs consisting of 1314 patients (conservative management = 662, ERCP= 652) were analyzed. There was a near significant decrease in mortality comparing ERCP and conservatively managed patients with severe pancreatitis with overall complications significantly reduced in the ERCP group. In those with mild disease, a strong trend to decreased morbidity in the ERCP group was seen, but mortality was unaffected, Systemic (renal, cardiac, respiratory, coagulation abnormalities and biliary sepsis,), and local complications (pseudocyst and pancreatic abscess formation) were not significantly improved through early ERCP.
CONCLUSIONS: This meta-analysis demonstrates a decrease in mortality with early ERCP ± ES versus conservative management in severe GSP, with a significant decrease in complications in this group.


Statistics for USQ ePrint 28114
Statistics for this ePrint Item
Item Type: Article (Commonwealth Reporting Category C)
Refereed: Yes
Item Status: Live Archive
Additional Information: Permanent restricted access to Published version due to publisher's copyright policy.
Faculty / Department / School: Current - Faculty of Health, Engineering and Sciences - School of Agricultural, Computational and Environmental Sciences
Date Deposited: 07 Dec 2015 06:17
Last Modified: 06 Feb 2018 04:08
Uncontrolled Keywords: fixed effects; heterogeneity; meta-analysis; quasi-likelihood; quality effects; random effects
Fields of Research : 11 Medical and Health Sciences > 1199 Other Medical and Health Sciences > 119999 Medical and Health Sciences not elsewhere classified
01 Mathematical Sciences > 0104 Statistics > 010402 Biostatistics
Socio-Economic Objective: E Expanding Knowledge > 97 Expanding Knowledge > 970111 Expanding Knowledge in the Medical and Health Sciences
E Expanding Knowledge > 97 Expanding Knowledge > 970101 Expanding Knowledge in the Mathematical Sciences
Identification Number or DOI: 10.1097/SLE.0000000000000142
URI: http://eprints.usq.edu.au/id/eprint/28114

Actions (login required)

View Item Archive Repository Staff Only