Incidence, severity, and mortality of post-ERCP pancreatitis: a systematic review by using randomized, controlled trials

• Published in: Gastrointestinal endoscopy 2015-01, Vol.81 (1), p.143-149.e9
• Main Authors: Kochar, Bharati, MD, Akshintala, Venkata S., MD, Afghani, Elham, MD, MPH, Elmunzer, B. Joseph, MD, Kim, Katherine J., MD, MPH, Lennon, Anne Marie, MD, PhD, Khashab, Mouen A., MD, Kalloo, Anthony N., MD, Singh, Vikesh K., MD, MSc
• Format: Article
• Language: English
• Subjects: Cholangiopancreatography, Endoscopic Retrograde - adverse effects; Gastroenterology and Hepatology; Humans; Incidence; Pancreatitis - epidemiology; Pancreatitis - etiology; Pancreatitis - mortality; Randomized Controlled Trials as Topic; Severity of Illness Index; Stents - adverse effects
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2014.06.045

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.