Elsevier

Gastrointestinal Endoscopy

Volume 81, Issue 1, January 2015, Pages 143-149.e9
Gastrointestinal Endoscopy

Original article
Clinical endoscopy
Incidence, severity, and mortality of post-ERCP pancreatitis: a systematic review by using randomized, controlled trials

Presented as a poster in the ASGE: ERCP-2 session at Digestive Disease Week, May 20, 2013, Orlando, Florida (Gastrointest Endosc 2013;77:AB392).
https://doi.org/10.1016/j.gie.2014.06.045Get rights and content

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).

Design

MEDLINE, EMBASE, and Cochrane databases were searched to identify RCTs evaluating the efficacy of drugs and/or pancreatic stents to prevent PEP.

Setting

Systematic review of patients enrolled in RCTs evaluating agents for PEP prophylaxis.

Patients

Patients in the placebo or no-stent arms of the RCTs

Intervention

ERCP.

Main Outcome Measurements

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.

Limitations

Difference in PEP risk among patients in the included RCTs.

Conclusion

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.

Section snippets

Medical literature search

This systematic review was conducted by using principles outlined in Cochrane Guidelines11 and Agency for Healthcare Research and Quality Methods Guide12 and reported in accordance with the PRISMA statement.13 The PubMed, Embase, and Cochrane databases were searched by using a combination of MeSH terms, Emtree terms, and key words to identify RCTs evaluating the efficacy of drugs and pancreatic stents to prevent PEP (Appendix 1, available online at www.giejournal.org). The search had no

Search results and study characteristics

The electronic searches provided 9094 titles, of which 103 RCTs met the inclusion criteria. Five additional studies were identified by a manual search, resulting in a total of 108 studies included in the analysis (Fig. 1, Appendix 2, available online at www.giejournal.org). Translators were used to include 7 trials in Chinese, 1 in Korean, 2 in German, 1 in Hungarian, 2 in Italian, and 2 in Spanish. The dates of publication ranged from 1977 to 2012. A total of 13,296 ERCPs were in the placebo

Discussion

This present systematic review evaluated the incidence, severity, and mortality of PEP in the placebo and no-stent arms of 108 RCTs from 1977 to 2012. The overall incidence of PEP was 9.7%. The incidence of severe PEP was 0.5%, and rate of mortality caused by PEP was 0.7%. Among the non–risk-stratified and high-risk RCTs, the incidence of PEP was 8.5% and 14.7%, respectively. The incidence of severe PEP and mortality caused by PEP was similar among patients in non–risk-stratified and high-risk

References (25)

  • B.J. Elmunzer et al.

    A meta-analysis of rectal NSAIDs in the prevention of post-ERCP pancreatitis

    Gut

    (2008)
  • A. Andriulli et al.

    Incidence rates of post ERCP complications: a systematic survey of prospective studies

    Am J Gastroenterol

    (2007)
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    DISCLOSURE: The following authors disclosed financial relationships relevant to this article: Dr Khashab is a consultant for Olympus and Boston Scientific. Dr Kalloo is an equity holder in Apollo Endosurgery. Dr Singh is a consultant for Santarus, D-Pharm, Abbvie, and Boston Scientific. All other authors disclosed no financial relationships relevant to this article.

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