Meta-analysis of randomized, controlled trials of endoscopic retrograde cholangiography (ERC) and endoscopic sphincterotomy (ES) in acute pancreatitis due to gallstones

V. K. Sharma, Colin Howden

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2 Citations (Scopus)

Abstract

The management of episodes of acute pancreatitis with gallstones in the common bile duct remains controversial. ERC with ES is advocated by some, but is also viewed as dangerous. Purpose: To review published randomized, controlled trials (RCTs) of the use of ERC+ES in patients with gallstone-related acute pancreatitis and to establish overall safety of this approach by meta-analysis. Methods: Literature search for published RCTs of ERC+ES in gallstone-related acute pancreatitis. Appropriate pooling of trial results by meta-analysis and calculation of number needed to treat (NNT) by ERC+ES for avoidance of complications or death. Results: Four published RCTs were identified. All had a numerically lower rate of complications in the ERC+ES group as compared to controls; three of the four RCTs had a numerically lower death rate in the treated groups compared to controls. After pooling the four RCTs, there were a total of 460 treated patients and 374 controls. Complications occurred in 115/460 treated patients (25.0%) and 143/374 controls (38.2%; z=4.10; P<0.001). Death occurred in 24/460 treated patients (5.21) compared to 34/374 controls (9.11; z=2.15; P<0.05). ERC+ES reduced the relative risk (RR) of complications by 34.61 and the RR of death by 42.91. Absolute risk reductions for complications and death were 13.21 and 3.91 respectively. The NNT's for complications and death were 7.6 and 25.6 respectively. Conclusions: In expert hands, ERC+ES in patients with acute gallstone pancreatitis is safe and reduces morbidity and mortality from this condition. It is necessary to treat approximately 26 patients by ERC+ES in order to save one life.

Original languageEnglish (US)
JournalGastrointestinal Endoscopy
Volume47
Issue number4
StatePublished - 1998
Externally publishedYes

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Endoscopic Sphincterotomy
Cholangiography
Gallstones
Pancreatitis
Meta-Analysis
Randomized Controlled Trials
Numbers Needed To Treat
Mortality
Hand
Morbidity
Safety

All Science Journal Classification (ASJC) codes

  • Gastroenterology

Cite this

@article{df6d669a30a84dddabbd2a2d38982696,
title = "Meta-analysis of randomized, controlled trials of endoscopic retrograde cholangiography (ERC) and endoscopic sphincterotomy (ES) in acute pancreatitis due to gallstones",
abstract = "The management of episodes of acute pancreatitis with gallstones in the common bile duct remains controversial. ERC with ES is advocated by some, but is also viewed as dangerous. Purpose: To review published randomized, controlled trials (RCTs) of the use of ERC+ES in patients with gallstone-related acute pancreatitis and to establish overall safety of this approach by meta-analysis. Methods: Literature search for published RCTs of ERC+ES in gallstone-related acute pancreatitis. Appropriate pooling of trial results by meta-analysis and calculation of number needed to treat (NNT) by ERC+ES for avoidance of complications or death. Results: Four published RCTs were identified. All had a numerically lower rate of complications in the ERC+ES group as compared to controls; three of the four RCTs had a numerically lower death rate in the treated groups compared to controls. After pooling the four RCTs, there were a total of 460 treated patients and 374 controls. Complications occurred in 115/460 treated patients (25.0{\%}) and 143/374 controls (38.2{\%}; z=4.10; P<0.001). Death occurred in 24/460 treated patients (5.21) compared to 34/374 controls (9.11; z=2.15; P<0.05). ERC+ES reduced the relative risk (RR) of complications by 34.61 and the RR of death by 42.91. Absolute risk reductions for complications and death were 13.21 and 3.91 respectively. The NNT's for complications and death were 7.6 and 25.6 respectively. Conclusions: In expert hands, ERC+ES in patients with acute gallstone pancreatitis is safe and reduces morbidity and mortality from this condition. It is necessary to treat approximately 26 patients by ERC+ES in order to save one life.",
author = "Sharma, {V. K.} and Colin Howden",
year = "1998",
language = "English (US)",
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journal = "Gastrointestinal Endoscopy",
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T1 - Meta-analysis of randomized, controlled trials of endoscopic retrograde cholangiography (ERC) and endoscopic sphincterotomy (ES) in acute pancreatitis due to gallstones

AU - Sharma, V. K.

AU - Howden, Colin

PY - 1998

Y1 - 1998

N2 - The management of episodes of acute pancreatitis with gallstones in the common bile duct remains controversial. ERC with ES is advocated by some, but is also viewed as dangerous. Purpose: To review published randomized, controlled trials (RCTs) of the use of ERC+ES in patients with gallstone-related acute pancreatitis and to establish overall safety of this approach by meta-analysis. Methods: Literature search for published RCTs of ERC+ES in gallstone-related acute pancreatitis. Appropriate pooling of trial results by meta-analysis and calculation of number needed to treat (NNT) by ERC+ES for avoidance of complications or death. Results: Four published RCTs were identified. All had a numerically lower rate of complications in the ERC+ES group as compared to controls; three of the four RCTs had a numerically lower death rate in the treated groups compared to controls. After pooling the four RCTs, there were a total of 460 treated patients and 374 controls. Complications occurred in 115/460 treated patients (25.0%) and 143/374 controls (38.2%; z=4.10; P<0.001). Death occurred in 24/460 treated patients (5.21) compared to 34/374 controls (9.11; z=2.15; P<0.05). ERC+ES reduced the relative risk (RR) of complications by 34.61 and the RR of death by 42.91. Absolute risk reductions for complications and death were 13.21 and 3.91 respectively. The NNT's for complications and death were 7.6 and 25.6 respectively. Conclusions: In expert hands, ERC+ES in patients with acute gallstone pancreatitis is safe and reduces morbidity and mortality from this condition. It is necessary to treat approximately 26 patients by ERC+ES in order to save one life.

AB - The management of episodes of acute pancreatitis with gallstones in the common bile duct remains controversial. ERC with ES is advocated by some, but is also viewed as dangerous. Purpose: To review published randomized, controlled trials (RCTs) of the use of ERC+ES in patients with gallstone-related acute pancreatitis and to establish overall safety of this approach by meta-analysis. Methods: Literature search for published RCTs of ERC+ES in gallstone-related acute pancreatitis. Appropriate pooling of trial results by meta-analysis and calculation of number needed to treat (NNT) by ERC+ES for avoidance of complications or death. Results: Four published RCTs were identified. All had a numerically lower rate of complications in the ERC+ES group as compared to controls; three of the four RCTs had a numerically lower death rate in the treated groups compared to controls. After pooling the four RCTs, there were a total of 460 treated patients and 374 controls. Complications occurred in 115/460 treated patients (25.0%) and 143/374 controls (38.2%; z=4.10; P<0.001). Death occurred in 24/460 treated patients (5.21) compared to 34/374 controls (9.11; z=2.15; P<0.05). ERC+ES reduced the relative risk (RR) of complications by 34.61 and the RR of death by 42.91. Absolute risk reductions for complications and death were 13.21 and 3.91 respectively. The NNT's for complications and death were 7.6 and 25.6 respectively. Conclusions: In expert hands, ERC+ES in patients with acute gallstone pancreatitis is safe and reduces morbidity and mortality from this condition. It is necessary to treat approximately 26 patients by ERC+ES in order to save one life.

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