Urgent Endoscopic Retrograde Cholangiopancreatography (ERCP) vs. Conventional Approach in Acute Biliary Pancreatitis Without Cholangitis: An Updated Systematic Review and Meta-Analysis.

Dhan B Shrestha,Bhesh Raj R Karki,Anurag Adhikari,Pravash Budhathoki,Binod Karki,Ayusha Poudel,Tul Maya Gurung,Yub Raj Sedhai,Barun B Aryal,Dhruvan Patel

doi:10.7759/cureus.21342

Abstract

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.

Highlights

BackgroundAcute pancreatitis (AP) is the most common pancreatic disease worldwide and one of the most common gastrointestinal causes of hospital admission [1,2]
This study aims to determine the usefulness of early endoscopic retrograde cholangiopancreatography (ERCP) in the management of acute biliary pancreatitis without concomitant cholangitis by comparing the outcomes reported in previous studies such as mortality, local and systemic complications, and hospital stay between patients undergoing early ERCP to patients who were managed conservatively
The study's significant findings were no differences in mortality, ICU admission, complications like pancreatic necrosis, pseudocyst, pneumonia development, and new-onset organ failure among patients with biliary pancreatitis without cholangitis with early ERCP compared to the control group

Summary

Introduction

BackgroundAcute pancreatitis (AP) is the most common pancreatic disease worldwide and one of the most common gastrointestinal causes of hospital admission [1,2]. Several observational studies and clinical trials have been performed comparing conservative management with ERCP in patients with biliary AP [7,8,9,10,11,12]. Fewer studies have been conducted focusing only on patients with biliary AP without concomitant cholangitis. A metaanalysis conducted in 2008 found that early ERCP did not cause a significant reduction in the risk of overall complications and mortality in cases of AP without cholangitis [13]. The American Gastroenterological Association Institute Technical Review in 2018 recommended ERCP to be performed between 24-48 hours after the diagnosis of acute biliary pancreatitis but did not specify the timing of ERCP in patients with acute pancreatitis without concomitant cholangitis and recommends further studies on this topic [14]

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Conclusion