Metaanalysis of Randomized Controlled Trials of Endoscopic Retrograde Cholangiography and Endoscopic Sphincterotomy for the Treatment of Acute Biliary Pancreatitis

Sharma, Virender K.; Howden, Colin W.
November 1999
American Journal of Gastroenterology;Nov1999, Vol. 94 Issue 11, p3211
Academic Journal
OBJECTIVE: Endoscopic retrograde cholangiography with endoscopic sphincterotomy (ERC+ES) has been advocated for the management of acute biliary pancreatitis. However, it is also viewed as dangerous. Our objective was to review published randomized, controlled trials (RCTs) of ERC+ES in patients with acute biliary pancreatitis and, by metaanalysis, to estimate the overall efficacy and safety of this approach. METHODS: We performed a fully recursive literature search for published RCTs of ERC+ES in gallstone-related acute pancreatitis. RCTs were pooled. Individual and overall mortality and complication rates were calculated, together with their 95% confidence intervals (CI), absolute risk reduction (ARR), relative risk reduction (RRR), and numbers needed to treat (NNT) for avoidance of complications or death. RESULTS: Four published RCTs had a numerically lower complication rate, and three had a numerically lower mortality rate, in the treated groups than in controls. After pooling, there were 460 treated patients and 374 controls. Complications occurred in 115 (25.0%) treated patients and 143 (38.2%) controls (z = 4.10; p < 0.001). Twenty-four treated patients (5.2%) and 34 controls (9.1%) died (z = 2.15; p < 0.05). ERC+ES had a 34.6% RRR for complications and a 42.9% RRR for death; ARR for complications and death was 13.2% (95% CI: 6.9-19.5%) and 3.9% (95% CI: 0.35-7.45%), respectively. The NNT for avoidance of complications and death was 7.6 and 25.6, respectively. CONCLUSIONS: ERC+ES reduces morbidity and mortality in patients with acute biliary pancreatitis. Treating 26 such patients with ERC+ES is predicted to save one life.


Related Articles

  • Expectant treatment or cholecystectomy after endoscopic retrograde cholangiopancreatography for choledocholithiasis in patients over 80 years old? Pring, C. M.; Skelding-Millar, L.; Goodall, R. J. R. // Surgical Endoscopy;Mar2005, Vol. 19 Issue 3, p357 

    Background: It is recommended that most patients between 18-80 years old, who have had an endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis, should be offered cholecystecytomy. However, we were uncertain whether this was the correct advice for patients...

  • Indomethacin May Reduce the Incidence and Severity of Acute Pancreatitis After ERCP. Sotoudehmanesh, Rasoul; Khatibian, Morteza; Kolahdoozan, Shadi; Ainechi, Sanaz; Malboosbaf, Ramin; Nouraie, Mehdi // American Journal of Gastroenterology;May2007, Vol. 102 Issue 5, p978 

    OBJECTIVES: Acute pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). Many medications have been used to prevent this complication. We aimed to evaluate the efficacy of rectally administered indomethacin for the prevention of post-ERCP...

  • Endoscopic Retrograde Cholangiopancreatography.  // Current Medical Literature: Gastroenterology;2008, Vol. 27 Issue 3, p84 

    The article discusses various studies concerning a medical procedure called endoscopic retrograde cholangiopancreatography (ERCP). This test carries an increased risk of pancreatitis, both because of the filling of the pancreas with radiographic dye and the possibility of edema in the ampulla...

  • Obstructing Pseudocyst of the Duct of Santorini in Pancreas Divisum. Browder, William; Gravois, Earl; Vega, Paul; Ertan, Atilla // American Journal of Gastroenterology;Mar1987, Vol. 82 Issue 3, p258 

    Pancreas divisum is a pancreatic duct anomaly that occurs due to failure of fusion of the dorsal and ventral ducts. While recognition of this anomaly is increasing due to more aggressive endoscopic retrograde cholangiopancreatography, its significance remains unclear. A patient with chronic...

  • A rare post-ERCP complication: a case report of pneumoperitoneum, pneumo-retroperitoneum, and surgical emphysema following unsuccessful ERCP. Samei, Hamada; Abdel, Raouf; Dowais, Ali M. Ai // Internet Journal of Surgery;2009, Vol. 21 Issue 1, p4 

    Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive procedure performed to diagnose and treat pancreatic and biliary diseases. In about 5%-10% of patients it causes adverse events. Pancreatitis is the most common complication; duodenal perforation, hemorrhage and cholangitis are...

  • Direct Cholangioscopy and Pancreatoscopy at Time of Endoscopic Retrograde Cholangiopancreatography. Kozarek, Richard A. // American Journal of Gastroenterology;Jan1988, Vol. 83 Issue 1, p55 

    Presents information on a study on the efficacy of endoscopic retrograde cholangiopancreatography. Methodology of the study; Diagnoses; Factors that contributed to the decline in the use of peroral cholangioscopy and pancreatoscopy.

  • Endoscopic basket impaction. Payne, Wyatt G.; Norman, James G. // American Surgeon;May1995, Vol. 61 Issue 5, p464 

    Focuses on the complications of Endoscopic Retrograde Cholangiopancreatography (ERCP) used for imaging the pancreatico-biliary tree and treating diseases of the pancreatic and biliary systems. Case of a 64-year-old white male presented with a four-week history of intermittent right upper...

  • METHOD OF PREVENTION OF ACUTE PANCREATITIS AFTER DIAGNOSTICS AND THERAPEUTIC ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY. Tolstokorov, A. S.; Sarkisian, Z. O.; Goch, E. M.; Volchkov, A. S.; Skopets, S. M.; Dergunova, S. A.; Rakhnayev, D. Ya. // Saratov Journal of Medical Scientific Research / Saratovskii Nau;Jul-Sep2012, Vol. 8 Issue 3, p749 

    Objective of the study: Prevention of acute pancreatitis after diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP). Material and Methods. Analysis of the results of diagnostic and therapeutic ERCP of the patients treated at Saratov Regional clinical hospital f during...

  • A Prospective Study of the Safety of Endoscopic Therapy for Choledocholithiasis in an Outpatient Population. Elfant, A. B.; Bourke, M. J.; Alhalel, R.; Kortan, P. P.; Haber, G. B. // American Journal of Gastroenterology;Aug1996, Vol. 91 Issue 8, p1499 

    Objective: Many centers routinely admit patients for observation after endoscopic therapy of choledocholithiasis although this is contrary to the current mandate for cost containment. The purpose of this study was to determine the safety, success, and complication rates of outpatient therapeutic...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics