Urgent Endoscopic Retrograde Cholangiopancreatography (ERCP) vs. Conventional Approach in Acute Biliary Pancreatitis Without Cholangitis: An Updated Systematic Review and Meta-Analysis.
Urgent Endoscopic Retrograde Cholangiopancreatography (ERCP) vs. Conventional Approach in Acute Biliary Pancreatitis Without Cholangitis: An Updated Systematic Review and Meta-Analysis.
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DOI：
10.7759/cureus.21342
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发表时间：
2022-01
期刊：
影响因子：
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通讯作者：
Patel D
中科院分区：
文献类型：
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作者：
Shrestha DB;Budhathoki P;Sedhai YR;Adhikari A;Poudel A;Aryal BB;Gurung TM;Karki B;Karki BR;Patel D
胆石病是急性胰腺炎的常见原因。早期内镜逆行胰胆管造影（ERCP）在不伴有胆管炎的胆源性胰腺炎中的作用尚不明确。因此，本研究旨在比较早期 ERCP 与保守治疗对不伴急性胆管炎的急性胆源性胰腺炎患者的结果。对 PubMed、PubMed Central、Embase、Scopus 和 ClinicalTrials.gov 数据库进行了在线检索，查找截至 2020 年 12 月 15 日发表的相关研究。使用 RevMan v 5.4（The Nordic Cochrane Centre、Cochrane Collaboration、Copenhagen）进行统计分析。使用具有 95% 置信区间的优势比 (OR) 进行结果估计。在数据库检索的 2700 篇研究中，我们最终分析了 4 篇研究。汇总数据显示死亡率没有显着降低（OR 0.59，95% CI 0.32 至 1.09；p=0.09）；总体并发症（OR 0.56，95% CI 0.30 至 1.01；p=0.05）；新发器官衰竭（OR 1.06，95% CI 0.65 至 1.75；p=0.81）；胰腺坏死（OR 0.80，95% CI 0.49 至 1.32；p=0.38）；胰腺假性囊肿（OR 0.44，95% CI 0.16 至 1.24；p=0.12）；入住 ICU（OR 1.64，95% CI 0.97 至 2.77；p=0.06）；与传统方法治疗不伴有胆管炎的急性胆源性胰腺炎相比，紧急 ERCP 治疗可减少和肺炎的发生（OR 0.81，95% CI 0.40 至 1.65；p=0.56）。此后，与保守治疗相比，早期 ERCP 治疗不伴胆管炎的急性胆源性胰腺炎并没有降低死亡率、并发症和其他不良后果。
Gallstone disease is the common cause of acute pancreatitis. The role of early endoscopic retrograde cholangiopancreatography (ERCP) in biliary pancreatitis without cholangitis is not well-established. Thus, this study aims to compare the outcome of early ERCP with conservative management in patients with acute biliary pancreatitis without acute cholangitis. An online search of PubMed, PubMed Central, Embase, Scopus, and Clinicaltrials.gov databases was performed for relevant studies published till December 15, 2020. Statistical analysis was performed using RevMan v 5.4 (The Nordic Cochrane Centre, Cochrane Collaboration, Copenhagen). Odds Ratio (OR) with a 95% confidence interval was used for outcome estimation. Among 2700 studies from the database search, we included four studies in the final analysis. Pooling of data showed no significant reduction in mortality (OR 0.59, 95% CI 0.32 to 1.09; p=0.09); overall complications (OR 0.56, 95% CI 0.30 to 1.01; p=0.05); new-onset organ failure (OR 1.06, 95% CI 0.65 to 1.75; p=0.81); pancreatic necrosis (OR 0.80, 95% CI 0.49 to 1.32; p=0.38); pancreatic pseudo-cyst (OR 0.44, 95% CI 0.16 to 1.24; p=0.12); ICU admission (OR 1.64, 95% CI 0.97 to 2.77; p=0.06); and pneumonia development (OR 0.81, 95% CI 0.40 to 1.65; p=0.56) by urgent ERCP comparing with conventional approach for acute biliary pancreatitis without cholangitis. Henceforth, early ERCP in acute biliary pancreatitis without cholangitis did not reduce mortality, complications, and other adverse outcomes compared to the conservative treatment.