Incidence, severity, and mortality of post-ERCP pancreatitis: A systematic review by using randomized, controlled trials

Bharati Kochar, Venkata S. Akshintala, Elham Afghani, B. Joseph Elmunzer, Katherine J. Kim, Anne Marie O'Broin-Lennon, Mouen Khashab, Anthony N Kalloo, Vikesh Singh

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)143-149.e9
JournalGastrointestinal Endoscopy
Volume81
Issue number1
DOIs
StatePublished - Jan 1 2015

Fingerprint

Endoscopic Retrograde Cholangiopancreatography
Pancreatitis
Randomized Controlled Trials
Mortality
Incidence
Stents
Placebos

ASJC Scopus subject areas

  • Gastroenterology
  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

Cite this

Incidence, severity, and mortality of post-ERCP pancreatitis : A systematic review by using randomized, controlled trials. / Kochar, Bharati; Akshintala, Venkata S.; Afghani, Elham; Joseph Elmunzer, B.; Kim, Katherine J.; O'Broin-Lennon, Anne Marie; Khashab, Mouen; Kalloo, Anthony N; Singh, Vikesh.

In: Gastrointestinal Endoscopy, Vol. 81, No. 1, 01.01.2015, p. 143-149.e9.

Research output: Contribution to journalArticle

@article{213936d567994409bbe1db3b28bd1005,
title = "Incidence, severity, and mortality of post-ERCP pancreatitis: A systematic review by using randomized, controlled trials",
abstract = "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.",
author = "Bharati Kochar and Akshintala, {Venkata S.} and Elham Afghani and {Joseph Elmunzer}, B. and Kim, {Katherine J.} and O'Broin-Lennon, {Anne Marie} and Mouen Khashab and Kalloo, {Anthony N} and Vikesh Singh",
year = "2015",
month = "1",
day = "1",
doi = "10.1016/j.gie.2014.06.045",
language = "English (US)",
volume = "81",
pages = "143--149.e9",
journal = "Gastrointestinal Endoscopy",
issn = "0016-5107",
publisher = "Mosby Inc.",
number = "1",

}

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 - O'Broin-Lennon, Anne Marie

AU - Khashab, Mouen

AU - Kalloo, Anthony N

AU - Singh, Vikesh

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.

UR - http://www.scopus.com/inward/record.url?scp=84923004695&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84923004695&partnerID=8YFLogxK

U2 - 10.1016/j.gie.2014.06.045

DO - 10.1016/j.gie.2014.06.045

M3 - Article

C2 - 25088919

AN - SCOPUS:84923004695

VL - 81

SP - 143-149.e9

JO - Gastrointestinal Endoscopy

JF - Gastrointestinal Endoscopy

SN - 0016-5107

IS - 1

ER -