Meta-analysis of early endoscopic retrograde cholangiopancreatography combined with endoscopic sphincterotomy versus conservative treatment in acute biliary pancreatitis

Abstract

Objective To evaluate the efficacy and safety of early endoscopic retrograde (ERCP) with endoscopic (EST) in patients of acute biliary (ABP). Methods Databases including PubMed, EMBASE, Cochrane library, CBM, CNKI, WanFang data and VIP data were searched with Endoscopic retrograde cholangiopancreatography Endoscopic sphincterotomy Pancreatitis Biliary pancreatitis resection up to September 2017. Randomized controlled trails (RCTs) conterning the comparison of ERCP with EST versus conservative management in ABP patients were enrolled in the study. Two reviewers independently screened literature, extracted data, and assess the risk of bias of the included studies. The Meta-analysis was conducted by RevMan 5.3 software. Results A total of 10 RCTs involving 1 752 cases were included in the Meta-analysis. The results of Meta-analysis showed that compared with the control group, early ERCP with EST reduced the systemic complication rate of ABP (RR=0.66; 95%CI: 0.47-0.93; P 0.05). Subgroup analyses indicated that early ERCP with EST therapy reduced the mortality of severe acute biliary (SABP), ABP with biliary obstruction and within 24 hours of admission (RR=0.48, 0.35, 0.25; 95%CI: 0.24-0.96, 0.17-0.74, 0.09-0.73; P<0.05); decreased the local and systemic complication rate of SABP, ABP with biliary obstruction (RR=0.56, 0.54, 0.51, 0.51; 95%CI: 0.37-0.86, 0.33-0.91, 0.32-0.81, 0.32-0.80; P<0.05); reduced the local and systemic complication rate of SABP (RR=0.42, 0.47; 95%CI: 0.25-0.70, 0.25-0.87; P<0.05) and shortened the hospital stay of SABP (MD=-11.22 d; 95%CI: -16.09--6.36; P<0.01). However, there were no significant differences of overall complication rate in ABP without biliary obstruction and hospital stay in MABP. Conclusion Early ERCP with EST therapy appears to be safe and effective for ABP patients. Key words: Cholangiopancreatography, endoscopic retrograde; Pancreatitis; Meta-analysis; Randomized controlled trail; Endoscopic