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.
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.
Authors: Xjnm Smeets; N Bouhouch; J Buxbaum; H Zhang; J Cho; R C Verdonk; Teh Römkens; N G Venneman; I Kats; J M Vrolijk; Gjm Hemmink; A Otten; Acitl Tan; B J Elmunzer; P B Cotton; Jph Drenth; Ejm van Geenen Journal: United European Gastroenterol J Date: 2019-02-27 Impact factor: 4.623