Preliminary results of meta-analysis of endoscopic retrograde cholangiopancreatography (ERCP) versus conservative treatment for gall stone pancreatitis
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Objectives: The aim was to conduct a meta-analysis of randomised control trials (RCTs) investigating the treatment of gallstone pancreatitis (GSP) by early ERCP versus conservative management and subsequent patient outcomes.
Data Sources and Review Methods: A search of Medline, Embase, Science Citation Index, Current Contents, PubMed and the Cochrane Database of Randomised control trials identified all RCTs comparing early ERCP to conservative treatment in gallstone pancreatitis published in the English Language. The meta-analysis was prepared with reference to the guidelines given in the Quality of Reporting of Meta-analysis (QUOROM) statement. Variables that were considered the most objective to analyse were overall mortality, overall morbidity, severity of pancreatitis (mild or severe), pseudocyst formation, organ failure (renal, respiratory and cardiac), abnormal coagulation, development of pancreatic abscess/phlegmon and biliary sepsis.
Results: Six trials were identified totalling 997 patients. There were significantly fewer complications in the active treatment group OR 1.78 (1.19, 2.67) with two further variables (pseudocyst formation and biliary sepsis) strongly favouring treatment but not reaching statistical significance. The other outcome variables examined showed no strong trend for either treatment regimen.
Conclusions: Early ERCP in the setting of acute GSP significantly decreases the risk of complications and biliary sepsis.
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