Treatment Of Acute Biliary Pancreatitis Research Articles

ОСТРЫЙ ПАНКРЕАТИТ БИЛИАРНОЙ ЭТИОЛОГИИ. Сообщение 2. СОВРЕМЕННЫЕ ПРИНЦИПЫ ДИАГНОСТИКИ И ЛЕЧЕНИЯ

Principles of diagnostics and treatment based on the international proved practical recommendations are presented. The peculiarities of the pathogenesis of the disease dictate the necessity of distinguishing acute biliary pancreatitis into a separate clinical category and determine essential differences in its treatment tactics in comparison with acute pancreatitis of other etiology. The key components of the complex treatment of acute biliary pancreatitis are curing (conservative or operative) of duct hypertension and cholecystectomy, preferably – laparoscopic, and the time period, when duct system decompression can prevent the progression of acute pancreatitis, does not exceed 48 hours after the disease beginning. Early laparoscopic cholecystectomy is a pathogenetically grounded method of the final treatment of acute pancreatitis of biliary etiology. Laparoscopic cholecystectomy should be performed during current hospitalization irrespective of the disease severity in all patients as soon as their condition allows to survive the intervention.

ОПЫТ ЛЕЧЕНИЯ ОСТРОГО ПАНКРЕАТИТА БИЛИАРНОЙ ЭТИОЛОГИИ

The general characteristics of the methods and results of the treatment of acute pancreatitis of biliary etiology for the period from January 1, 2012 to December 31, 2021 are presented. Patients with acute biliary pancreatitis are cared for based on the key principles of acute pancreatitis treatment of any other etiology – the long-term multicomponent intensive therapy aimed to relieve the syndrome of the systemic inflammatory response, to prevent multiple organ failure and infection of pancreatic necrosis foci, to refuse direct surgical interventions at the early stage of the disease, the reasonable use of minimally invasive draining interventions and the use of a regimen of repeated programmed operations to actively control all areas of necrotic destruction and infection to prevent the development of intra-abdominal complications. Currently the key component of complex treatment of acute pancreatitis of biliary etiology is unanimously considered as the relief (conservative or surgical) of pancreatobiliary ductal hypertension. Early laparoscopic cholecystectomy with choledochal drainage according to Halsted is a pathogenetically substantiated method of choosing the final treatment for acute biliary pancreatitis and should be performed regardless of the severity of the disease during the current hospitalization in all patients, as soon as their condition allows them to transfer the intervention. Early laparoscopic cholecystectomy with choledochal drainage according to Halsted is a pathogenetically grounded method of choice of the definitive treatment of acute biliary pancreatitis etiology and should be carried out regardless of the disease severity in the period of the current hospitalization for all patients as soon as their state allows to survive the intervention. Lethal outcomes at moderately severe and severe acute biliary pancreatitis are almost evenly distributed according to the terms (till/later than 2 weeks) after the disease beginning; their main cause is progressing multiple organ failure both in the aseptic course of the disease and at pancreatic necrosis infection.

Assessment of early results of surgical treatment of acute biliary pancreatitis at Viet Duc University Hospital

treatment requires radical treatment. ERCP, percutaneous lithotripsy, and surgery are effective treatments. The purpose of this paper is to evaluate the early results of surgical treatment of acute biliary pancreatitis. Patients and methods: A retrospective review of all patients diagnosed with acute pancreatitis due to gallstones was surgically treated at the Department of Hepatobiliary Surgery of Viet Duc University Hospital from January 2019 to December 2021. Results: The study group has 49 patients (26 female, 23 male). The mean age at surgery was 56.8 (28-87 years). CT scan identified 100% of pancreatic lesions and gallstones before surgery, of which common bile duct stones accounted for 20.4%, the rest were common bile duct stones combined with gallstones and stones in the liver. One patient was diagnosed with septic shock caused by cholangitis had to be resuscitated before surgery. The surgical intervention on biliary tract was cholecystectomy, stone removal, endoscopic lithotripsy, T tube drainage, combined cholecystectomy and left lobectomy. Open surgery was performed on 35 patients, accounting for 71.4%, and laparoscopic surgery accounted for 28.6%. The intervention on the pancreas was on 8 patients, mainly removing the necrotic pancreatic tissue, draining the lesser sac. Most patients had surgery in the first 2 days, as early as 22 hours, as late as 8 days. There were two patients complicated the surgical site infection, two patients with biliary leak, one patient with acute pancreatitis, all were treated medically. The mean hospital stay was 5.1 days. Laparoscopic surgery gave good results, accounting for 92.9%, there were no severe cases of recurrence or death. 49 patients were followed up 30 days after surgery with a good result (85.7%), no mortality was observed. Conclusion: Surgical treatment for acute biliary pancreatitis is safe which assesses pancreatic damage, gives good postoperative results. Keywords: Acute pancreatitis, gallstones, surgery

Acute biliary pancreatitis: the evolution of surgical tactics (review of literature)

Surgical treatment of acute biliary pancreatitis over the past decades have been improved from realization of open traumatic surgical interventions to the use of minimally invasive technologies. However, despite the progress in the treatment of this pathology, the question of the timing of cholecystectomy after endoscopic papillosphincterotomy with lithoextraction remains unresolved. In some cases, after the endoscopic papillosphincterotomy, a recurrence of the disease occurs, as well as other various biliary complications, such as: acute calculous cholecystitis, choledocholithiasis, cholangitis, associated with the fact that the main etiological factor – the gallstone disease – has not been eliminated, specifically, cholecystectomy was not performed.The objective of this study was to analyze the evolution of surgical tactics in the treatment of acute biliary pancreatitis with combined cholecystocholedocholithiasis.

Clinical efficacy of endoscopic retrograde cholangiopancreatography in the treatment of acute biliary pancreatitis: a meta-analysis.

Acute biliary pancreatitis (ABP) is a type of acute abdomen caused by biliary tract diseases that trigger outflow obstruction, hypertension of the pancreatic duct, and subsequent pancreatic autodigestion. To investigate the clinical efficacy of endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of ABP. A comprehensive literature search was performed on four databases (PubMed/WOS/CNKI/Wanfang) to select randomized controlled trials on ERCP for ABP published between 2010 and 2022. Relevant data were then extracted from the eligible studies. Subsequently, meta-analysis and sensitivity analysis were performed using Stata 16.0 statistical software. Publication bias was determined using funnel plots created by the Begg method. A total of 1639 patients with ABP were included, of whom 823 were in the observation (ERCP or ERCP + endoscopic sphincterotomy) group and 816 in the control (conservative treatment) group. The observation group demonstrated a higher response rate, lower incidence of complications, and superior postoperative abdominal pain relief time, time to intestinal exhaust, serum amylase recovery time and hospital stay than the control group (p < 0.05). In addition, biochemical parameters and inflammatory factor levels (Tbil/WBC/CRP/TNF-α) were significantly better after treatment in the observation group than in the control group (p < 0.05). Collectively, ERCP in the treatment of ABP was associated with relief of abdominal pain, accelerated intestinal exhaust and serum amylase recovery, and effective improvements in serum biochemical parameters and inflammatory factor levels.

Efficacy and safety of endoscopic retrograde cholangiopancreatography for the treatment of acute biliary pancreatitis with or without cholangitis

Objective: To evaluate the result of endoscopic retrograde cholangiopancreatography (ERCP) for treatment of acute biliary pancreatitis (ABP) with or without cholangitis. Subject and method: A retrospective cohort study, 30 patients of ABP at Institute of Gastroenterology and Hepatology, 108 Military Central Hospital, from January 2019 to November 2021. Result: We divided the patients into 2 groups: 19 patients ABP with cholangitis, 11 patients without cholangitis. Mean age: 60.7 ± 17.9 (26 - 92), male/female (1.5). The technical success rates were 94.7% and 100%, the clinical success rates were 100% and 90.9% of the two groups with and without cholangitis, respectively. The concomitant cholangitis was not associated with the timing of ERCP (p=0.192), technical success rate (p=0.439), and clinical success rate (p=0.367). And the total length of hospital stay was not different between the two groups (7.7 ± 3 vs. 7.7 ± 4.1 days, p=0.974). No significant differences were found in the duration of hospital after ERCP or procedural-related complications, in patients with acute biliary pancreatitis, according to the concomitant disease (with vs without cholangitis). Conclusion: These findings support ERCP could be performed effectively and safely in acute biliary pancreatitis with or without cholangitis.

Мinimally invasive stent technologies in hepatopancreatobiliary surgery

Aim. To compare the aspects of the use of various stents in hepatopancreatobiliary zone diseases.Materials and methods. We analyzed the experience of using biliary plastic and metal self-expanding stents placed by the antegrade percutaneous (n = 45) or retrograde endoscopic method (n = 160). Pancreatic stenting with 5 Fr plastic stents was performed in 35 patients.Results. Our experience shows the high efficiency of stenting performed by antegrade and endoscopic retrograde access for bile and pancreatic ducts obstruction. Pancreatic stenting is justified in the prevention of acute pancreatitis (in the presence of a risk factor) and in treatment of post-ERCP pancreatitis, as well as in the treatment of acute biliary pancreatitis with impacted stone in papilla Vater.Conclusion. Minimally invasive technologies has a leading role in the treatment of patients with ductal failure of the hepatopancreatobiliary zone. Stenting should be used to prepare for radical surgery or as a final palliative treatment method. A differentiated approach is important in selecting a stent, depending on the specific clinical task. For biliary drainage in patients with obstructive jaundice of various etiologies, it is permissible to use both the retrograde and antegrade stenting. The choice of the decompression method depends on the level of the biliary obstruction, the cause of obstructive jaundice, the technical equipment of the department and the training of specialists in retrograde and (or) antegrade endobiliary technologies. Antegrade access is preferred for proximal obstruction of the bile ducts, retrograde endoscopic access is preferred for distal obstruction.

Surgical treatment of acute biliary pancreatitis

The objective was to improve the management of patients with acute biliary pancreatitis against the background of cholecystocholedocholithiasis.Methods and materials. 107 patients with acute biliary pancreatitis against the background of cholecystocholedocholithiasis were treated between 2017 and 2020 years. Patients suffering from mild and moderately severe acute biliary pancreatitis underwent single-step (laparoscopic cholecystectomy with endoscopic papillosphincterotomy) or two-step (endoscopic papillosphincterotomy with delayed laparoscopic cholecystectomy) surgical interventions. Patients with severe acute pancreatitis underwent endoscopic papillosphincterotomy with or without common bile duct and pancreatic duct stenting. The comparative analysis was made to estimate the efficiency of different surgical interventions in different groups of patients.Results. Patients with mild or moderately severe acute biliary pancreatitis showed better outcomes after single-step surgical intervention. Patients with severe acute biliary pancreatitis – after endoscopic papillosphincterotomy with common bile duct and pancreatic duct stenting.Conclusion. Single-step surgical interventions (laparoscopic cholecystectomy with endoscopic papillosphincterotomy) are shown for patients with mild or moderately severe acute biliary pancreatitis, because this approach helps to preserve the complications, specific for two-step interventions. The single-step approach authentically helps to decrease the duration of hospital stay and reduce treatment costs. The two-step approach is shown for patients with severe acute biliary pancreatitis, but endoscopic papillosphincterotomy with lithoextraction should be supplemented by common bile duct and pancreatic duct stenting, in order to reduce the number of complications associated with delayed cholecystectomy.

Comparison of early and delayed cholecystectomy for biliary pancreatitis: A meta-analysis

BackgroundBiliary stones are the most common etiology of acute pancreatitis Cholecystectomy has been accepted as a popular treatment for acute biliary pancreatitis (ABP) to reduce the risk of recurrent complications. However, the precise time of intervention still remains controversial. ObjectiveThe aim of this meta-analysis was to compare early and delayed cholecystectomy and determine the most precise timing of cholecystectomy following gallstone pancreatitis. MethodSearch the publications on comparison the efficacy of early cholecystectomy comparison with delayed cholecystectomy in treatment outcomes of ABP to October, 2018. After rigorous reviewing on quality, the data was extracted from eligible trials. All trials analyzed the summary hazard ratios (HRs) of the endpoints of interest, including survival data and individual postoperative complications. ResultsA total of 9 trials were met our inclusion criteria. The pooled results indicate that postoperative complications、readmission rate、conversion to an open procedure and cholecystectomy-related morbidity/mortality did not have statistical significance (P > 0.05) between the early and delayed cholecystectomy. While, the length of hospital stay was shorter for the early cholecystectomy group than the delayed group in all included studies. ConclusionsAlthough the efficacy of delayed intervention in terms of inflammation reduction is definite, their adverse events are often major limitations. In the present study, an early cholecystectomy may result in a significantly shortened hospital stays without increased complications or mortality.

Effect of Diclofenac Suppository on Treatment of Acute Biliary Pancreatitis

Effect of Diclofenac Suppository on Treatment of Acute Biliary Pancreatitis

Treatment of acute pancreatitis with pancreatic duct decompression via ERCP: A case report series.

Acute pancreatitis is a common disorder in the gastrointestinal system, which is characterized by an increasing incidence and a high mortality. Currently, symptomatic treatment becomes the predominant option for the treatment of acute pancreatitis. To date, there is little knowledge on the treatment of acute pancreatitis through alleviation of pancreatic ductal hypertension and removal of pancreatic ductal obstruction. Endoscopic retrograde cholangiopancreatography (ERCP), an effective treatment for acute biliary pancreatitis, may alleviate the obstruction and edema in the common channel of the bile duct and pancreatic duct, to achieve the indirect treatment of acute pancreatitis, and may achieve the removal of intrapancreatic ductal obstruction and reduction in the intrapancreatic ductal pressure. Hereby, we report 3 cases with acute pancreatitis that were successfully treated by the pancreatic duct decompression via ERCP in one single center from China. Our data demonstrate that pancreatic duct decompression via ERCP is effective for the treatment of acute pancreatitis, which may shorten the course of acute pancreatitis through alleviating pain, shortening fasting duration and controlling the inflammatory reactions. It is recommended to use further prospective, randomized, controlled clinical trials to evaluate the efficacy and safety of pancreatic duct decompression via ERCP for acute pancreatitis.

Outcomes of delayed endoscopic retrograde cholangiopancreatography in patients with acute biliary pancreatitis with cholangitis

ObjectiveThe recommended treatment for acute biliary pancreatitis(ABP) with cholangitis is urgent endoscopic retrograde cholangiopancreatography(ERCP). However, tight schedules in the endoscopy room mean that urgent ERCP may not always be performed. This study aimed to compare the outcomes of early (≤72 h) and delayed(>72 h) ERCP in patients with ABP with cholangitis. MethodsNinety-five patients diagnosed with ABP with cholangitis who underwent ERCP between May 2012 and April 2018 were retrospectively reviewed. ResultsSixty-seven patients(70.5%) were classified in the early ERCP and 28(29.5%) in the delayed ERCP groups. There was no significant difference in pancreatitis severity between the groups. Total bilirubin was higher in the early compared with the late ERCP group (5.7 ± 5.2 versus 3.5 ± 2.3 mg/dL, p = 0.03). Fewer patients in the early group had end-stage renal disease (0 versus 3, p = 0.006) and relatively fewer patients in the early group took aspirin (15(22.4%) versus 12(42.9%), p = 0.04). There were no significant differences between the early and delayed ERCP groups in terms of mortality (2(3.0%) versus 0), disease-related complications(11 (16.4%) versus 5(17.9%), p = 0.86), or ERCP-related complications(5(7.5%) versus 3(10.7%), p = 0.60). The total length of stay(LoS) was shorter in the early group(6.3 ± 4.4 versus 9.8 ± 6.1 days, p = 0.002). The rate of complete stone removal was lower in the early compared with the delayed ERCP group(32/42(76.2%) versus 18/18(100%), p = 0.02). ConclusionDelayed ERCP can be performed in selected patients with ABP with cholangitis, with similar complication rates but longer LoS compared with early ERCP.

Different approaches in diagnosis, follow-up and treatment of acute biliary pancreatitis: Results of attitude survey.

Acute biliary pancreatitis is one of the most frequently encountered diseases among general surgeons in emergency surgical diseases. Differences in diagnosis and treatment management of these patients, varying from physician to physician, are common in clinical practice. We aimed to present these differences and discuss the results in the light of current guidelines in the literature. In this study, 21 questions were prepared regarding the physicians' approach in the diagnosis, follow-up and treatment of acute biliary pancreatitis (Appendix).The questionnaires were completed by face to face interviews with 94 general surgery specialists at the 20th National Surgery Congress. In this study, 38 (40%) of the physicians who answered the questionnaire were working in the Training and Research Hospital, 27 (29%) in the State Hospital, 19 (20%) in the University Hospital and nine in private health care was working in the establishment. 85% of the physicians were general surgery specialists with 10 years of experience. 53% (50) of the surgeons reported that they had less than five cases of acute biliary pancreatitis each month, and 35% (34) stated that they wanted amylase value daily for follow-up. Ultrasonography and computed tomography were the most commonly used imaging modalities and 15% of the respondents indicated that each patient underwent magnetic resonance cholangiopancreatography. 45% of surgeons stated that antibiotics were started at the time of diagnosis of pancreatitis. The percentage of surgeons who did not undergo cholecystectomy early in patients with mild to moderate pancreatitis was 60%. The reason for not preferring surgery in the early period was the most frequent operation difficulty with 40% and not supporting the operation in the early period. According to the attitude survey results, there are differences between general surgery specialists in the diagnosis, follow-up and treatment of acute biliary pancreatitis.

Analysis of operation timing and clinical efficacy of endoscopic retrograde cholangiopancreatography in the treatment of acute biliary pancreatitis

Objective To discuss the operation timing, clinical efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of acute biliary pancreatitis. Methods Retrospective analyzed the clinical data of 65 acute biliary pancreatitis patients in First People′s Hospital of Jiangxia District, Wuhan city form October 2015 to July 2017, there were 45 males and 30 females, the age was (46.35±8.95) years (range, 25-72 years). All patients were treated with ERCP, and divided into 24-72 h group (the time from onset to ERCP treatment 24-72 h) 16 cases, 72-120 h group (the time from onset to ERCP treatment 72-120 h) 25 cases and ≥120 h group(the time from onset to ERCP treatment ≥120 h) 34 cases, recorded and compared the clinical indexes during and after operation, laboratory indexes before and after treatment, incidence of surgical complications, recurrence rate and mortality.The measurement data with normal distribution were expressed as mean±standard deviation (Mean±SD), the F test was used for comparison among the three groups, and the t test was used for comparison between the two groups, the count data were compared by χ2 test, and the rank sum test was used to compare the incidence of surgical complications. Results The abdominal pain relief time, amylase recovery time, length of stay and hospitalization expenses of the 24-72 h group were (4.48±1.29) d, (3.59±1.22) d, (7.24±1.55) d and (1.55±0.31) ten thousand yuan respectively, the 72-120 h group were (7.35±1.76) d, (4.91±1.37) d, (13.61±2.13) d, (2.02±0.37) ten thousand yuan respectively, the ≥120 h group were (11.21±2.02) d, (8.86±1.95) d, (21.58±2.86) d, (2.49±0.52) ten thousand yuan respectively, with significant differences between any two groups(P 0.05). Conclusion In the treatment of acute biliary pancreatitis within 24-72 h and 72-120 h are safe and effective, but the improvement of laboratory indexes within 24-72 h ERCP treatment is more obvious, the length of stay is shorter, the hospitalization expenses is more provincial, and with more clinical advantage. Key words: Cholangiopancreatography, endoscopic retrograde; Pancreatitis; Postoperative complications; Safety

Timing of Cholecystectomy in Mild Acute Biliary Pancreatitis.

Acute biliary pancreatitis (ABP) is one of the most common gastrointestinal events that requires acute admission to the hospital with considerable risks of mortality &amp; morbidity. Laparoscopic cholecystectomy has become the gold standard for the treatment of ABP. Our aim was to determine the safety of cholecystectomy during the first admission by performing a review of the current literature. Waiting for 6 - 8 weeks to perform cholecystectomy may result with an increased incidence of recurrent ABP attacks, which may increase morbidity and the length of the hospital stay. On the contrary, cholecystectomy during the index admission for mild ABP appears to be a preferable and safe approach with better surgical outcomes providing a definitive treatment.

CURRENT ASPECTS OF DIAGNOSTICS AND TREATMENT OF ACUTE BILLARIAN PANCREATITIS

Relevance. The article is devoted to the problem of diagnosis and treatment of acute biliary pancreatitis, which remains one of the most common surgical diseases of the abdominal cavity and accounts for 33.2% of the total number of patients with acute pancreatitis.&#x0D; Objective of the work is to improve the diagnosis and results of surgical treatment of patients with acute pancreatitis of biliary etiology.&#x0D; Materials and methods. The results of treatment of 264 patients with acute pancreatitis of biliary etiology are analyzed. Operative treatment was applied in 92 (34,8 %) patients: endoscopic operations were performed in 44 patients (16,7 %). Thus, in 10 (3,8 %) patients, endoscopic papilloprotectomy was performed with the auditory of the duct system and the extraction of concrements. In other cases, organo-preserving intervention was performed without disturbing the morphofunctional integrity of the sphincter apparatus of the duct system: the cannulation in 6 (2,3%) patients, mechanical (balloon) in 5 (1,9 %) cases, pharmacological (myogenic antispasmodic) dilatation of distal duct and a large duodenal papilla in 11 (4,2 %) patients. In residual choledocholithiasis, a technique of papillotomy under the control of choledochoscopy was proposed – 12 (4,54 %) patients. A comparative analysis of the effectiveness of the treatment of patients who used the "open" (comparative group) and noninvasive endoscopic interventions in the early disease (the main group) was performed.&#x0D; Results. So in the main group the length of stay in the hospital was 12±3,2 days, respectively, in the comparison group – 26±4,3 days. In 42 (95,4 %) patients who had undergone endoscopic surgery, a positive clinical effect, a rapid regress of the symptoms of acute pancreatitis was achieved. In two (4,5 %) patients in the main group, the course was complicated by the development of the abscess of the stuffing box, and puncture under ultrasound control was performed. In patients of the comparison group complications arose in 5 (41,6 %) patients, it is noteworthy that all of them had undergone operative interventions, which were limited only to the rehabilitation and drainage of the abdominal cavity, a stuffing box bag. The mortality rate among unopposed was 1,2 % (2 patients), and among the operated – 11,9 % (11 patients). Among prooperated patients who died, 81,8 % (9 people) were elderly patients.&#x0D; Conclusions. The use of minimally invasive endoscopic interventions in the early phase of the disease reduces the length of stay of patients in the hospital from 26±4,3 days (comparison group) to 12 3,2 days (main group) and the number of complications occurring by 37,1 % (P &lt;0, 05). Application of the proposed method of papillotomy under the control of choledochoscopy makes it possible to reduce the risk of perforation of the wall of the duodenum with the development of peritonitis or retroperitoneal phlegmon by 1,2 % (P &lt;0,05).

The Methodological Quality of an Article of Treatment on Early Ductal Decompression Versus Conservative Treatment for Gallstone Pancreatitis with Ampullary Obstruction

Early ductal decompression in the treatment of acute biliary pancreatitis with ampullary obstruction is controversial. The objective of this study is to determine the methodological quality, internal and external validity of the article of Acosta et al. (2006), that compares the effectiveness of early ductal decompression versus conservative management in acute biliary pancreatitis with ampullary obstruction. Acosta et al., article was subjected to a therapy User’s Guide. Subsequently its methodological quality was analyzed applying 3 instruments; MINCIR therapy, CONSORT and SIGN. The application of these instruments was performed independently by four researchers, trained in critical analysis of the literature and clinical epidemiology. The article is not oriented to a definite question. It has a random assignment of participants, but these were not properly considered until the end of the study. It has 16 points of MINCIR scale (cut-off of the methodological quality construct is 18). Fulfills with only 10 of the 21 items of CONSORT. All the instruments used put in evidence similar methodological weaknesses that lead to questioning of the internal and external validity of the study, a fact that in turn makes questioning the logic of the applicability of this protocol.

Methodological Quality of an Article for Treatment in Early Ductal Decompression versus Conservative Treatment in Gallstone Pancreatitis with Ampullary Obstruction

Early ductal decompression in the treatment of acute biliary pancreatitis with ampullary obstruction is controversial. The objective of this study is to determine the methodological quality, internal and external validity of the article of Acosta et al. (2006), which compares the effectiveness of early ductal decompression versus conservative management in acute biliary pancreatitis with ampullary obstruction. Acosta et al. (2006), article was subjected to a therapy User’s Guide. Subsequently its methodological quality was analyzed applying 3 instruments; MINCIR therapy, CONSORT and SIGN. The application of these instruments was performed independently by four researchers, trained in critical analysis of the literature and clinical epidemiology. The article is not oriented to a definite question. It has a random assignment of participants, but these were not properly considered until the end of the study. It has 16 points of MINCIR scale (cut-off of the methodological quality construct is 18). It complies with only 10 of the 21 items of CONSORT. All instruments used put into evidence similar methodological weaknesses that lead to questioning of the internal and external validity of the study, a fact that in turn questions the logic of the applicability of this protocol.

Early surgical treatment of acute biliary pancreatitis

Early surgical treatment of acute biliary pancreatitis

Early Endoscopic Retrograde Cholangiopancreatography Versus Conservative Treatment in Patients With Acute Biliary Pancreatitis: Systematic Review and Meta-analysis of Randomized Controlled Trials.

The aim of the study was to evaluate the role of early endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of acute biliary pancreatitis, in comparison with conservative treatment. Systematic review via databases (MEDLINE [PubMed], Latin-American and Caribbean Health Sciences Literature database, Embase, Cochrane Central, and the [Brazilian] Regional Library of Medicine) is conducted. We analyzed 10 randomized controlled trials (1091 patients). Outcomes were the following: local and systemic adverse events; acute cholangitis; death; length of hospital stay; cost; abdominal pain; and time to a reduction in body temperature. For the meta-analysis, we used risk difference (RD) and mean with standard deviation as measures of variability. There was a statistically significant difference between the patients submitted to ERCP in terms of the following: local adverse events (RD, 0.74; 95% confidence interval [CI], 0.55-0.99), time to pain relief and time to a reduction in axillary temperature (RD, -5.01; 95% CI, -6.98 to -3.04, and RD, -1.70; 95 CI%, -2.33 to -1.08, respectively). Patients undergoing ERCP spent less time in hospital (RD, -11.04; 95% CI, -15.15 to -6.93). Cost was lower in the group treated with ERCP. Early ERCP decreases local adverse events, shortening the time to pain relief, to a reduction in axillary temperature, hospital stays, and cost in patients with acute biliary pancreatitis.