TY - JOUR
T1 - Incidence, severity, and mortality of post-ERCP pancreatitis
T2 - A systematic review by using randomized, controlled trials
AU - Kochar, Bharati
AU - Akshintala, Venkata S.
AU - Afghani, Elham
AU - Joseph Elmunzer, B.
AU - Kim, Katherine J.
AU - Lennon, Anne Marie
AU - Khashab, Mouen A.
AU - Kalloo, Anthony N.
AU - Singh, Vikesh K.
N1 - Publisher Copyright:
© 2015 American Society for Gastrointestinal Endoscopy.
PY - 2015/1/1
Y1 - 2015/1/1
N2 - 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.
AB - 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.
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U2 - 10.1016/j.gie.2014.06.045
DO - 10.1016/j.gie.2014.06.045
M3 - Article
C2 - 25088919
AN - SCOPUS:84923004695
SN - 0016-5107
VL - 81
SP - 143-149.e9
JO - Gastrointestinal endoscopy
JF - Gastrointestinal endoscopy
IS - 1
ER -