Incidence, severity, and mortality of post-ERCP pancreatitis: an updated systematic review and meta-analysis of 145 randomized controlled trials

Akshintala, Venkata S.; Kanthasamy, Kavin; Bhullar, Furqan A.; Weiland, Christina; Kamal, Ayesha; Kochar, Bharati; Gürakar, Merve; Ngamruengphong, Saowanee; Kumbhari, Vivek; Brewer-Guiterrez, Olaya I; Kalloo, Anthony N.; Khashab, Mouen A.; Geenen, Erwin-Jan M. van; Singh, Vikesh K.

doi:10.1016/j.gie.2023.03.023

Cited by 37 publications

(7 citation statements)

References 128 publications

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“…The overall incidence of all postoperative complications of ERCP worldwide is 6–15%, with PEP remaining the most common complication [ 11 ]. A 2023 meta-analysis of PEP morbidity and mortality based on 145 RCTs ( n = 19,038) showed an overall incidence of PEP of 10.2% and an incidence of 14.1% in high-risk patients [ 12 ]. In this study, as one of the first centers in China to carry out ERCP-related procedures, our incidence of PEP was 5.22%, which was lower than the overall incidence worldwide.…”

Section: Discussionmentioning

confidence: 99%

Prediction for post-ERCP pancreatitis in non-elderly patients with common bile duct stones: a cross-sectional study at a major Chinese tertiary hospital (2015–2023)

Yan,

Zheng,

Tang

et al. 2024

BMC Med Inform Decis Mak

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Background Post-ERCP pancreatitis is one of the most common adverse events in ERCP-related procedures. The purpose of this study is to construct an online model to predict the risk of post-ERCP pancreatitis in non-elderly patients with common bile duct stones through screening of relevant clinical parameters. Methods A total of 919 cases were selected from 7154 cases from a major Chinese tertiary hospital. Multivariable logistic regression model was fitted using the variables selected by the LASSO regression from 28 potential predictor variables. The internal and external validation was assessed by evaluating the receiver operating characteristic curve and the area under curve. Restricted cubic spline modelling was used to explore non-linear associations. The interactive Web application developed for risk prediction was built using the R “shiny” package. Results The incidence of post-ERCP pancreatitis was 5.22% (48/919) and significantly higher in non-elderly patients with female, high blood pressure, the history of pancreatitis, difficult intubation, endoscopic sphincterotomy, lower alkaline phosphatase and smaller diameter of common bile duct. The predictive performance in the test and external validation set was 0.915 (95% CI, 0.858–0.972) and 0.838 (95% CI, 0.689–0.986), respectively. The multivariate restricted cubic spline results showed that the incidence of pancreatitis was increased at 33–50 years old, neutrophil percentage > 58.90%, hemoglobin > 131 g/L, platelet < 203.04 or > 241.40 × 109/L, total bilirubin > 18.39 umol / L, aspartate amino transferase < 36.56 IU / L, alkaline phosphatase < 124.92 IU / L, Albumin < 42.21 g / L and common bile duct diameter between 7.25 and 10.02 mm. In addition, a web server was developed that supports query for immediate PEP risk. Conclusion The visualized networked version of the above model is able to most accurately predict the risk of PEP in non-elderly patients with choledocholithiasis and allows clinicians to assess the risk of PEP in real time and provide preventive treatment measures as early as possible.

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Section: Discussionmentioning

confidence: 99%

Prediction for post-ERCP pancreatitis in non-elderly patients with common bile duct stones: a cross-sectional study at a major Chinese tertiary hospital (2015–2023)

Yan,

Zheng,

Tang

et al. 2024

BMC Med Inform Decis Mak

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“…ERCP remains the first-line modality for biliary decompression but can be unsuccessful in up to 15% of cases ( 14 , 15 ). There are also associated risks of adverse events, particularly post-ERCP pancreatitis, with an incidence of up to 14% depending on underlying risk factors ( 48 ). The theoretical advantage of avoiding pancreatitis in patients undergoing EUS-BD as opposed to ERCP is also attractive.…”

Section: Eus-guided Interventions In Pancreatic Cancermentioning

confidence: 99%

Utility of interventional endoscopic ultrasound in pancreatic cancer

On,

Ahmed,

Everett

et al. 2023

Front. Oncol.

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Endoscopic ultrasound (EUS) has an important role in the management algorithm of patients with pancreatic ductal adenocarcinoma (PDAC), typically for its diagnostic utilities. The past two decades have seen a rapid expansion of the therapeutic capabilities of EUS. Interventional EUS is now one of the more exciting developments within the field of endoscopy. The local effects of PDAC tend to be in anatomical areas which are difficult to target and endoscopy has cemented itself as a key role in managing the clinical sequelae of PDAC. Interventional EUS is increasingly utilized in situations whereby conventional endoscopy is either impossible to perform or unsuccessful. It also adds a different dimension to the host of oncological and surgical treatments for patients with PDAC. In this review, we aim to summarize the various ways in which interventional EUS could benefit patients with PDAC and aim to provide a balanced commentary on the current evidence of interventional EUS in the literature.

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“…Nevertheless, the prevention of PEP is a substantial challenge for endoscopists 8 . PEP has been associated with such potential factors as di cult cannulation and inadvertent manipulation of the pancreatic duct (PD), which can trigger impaired ow of pancreatic secretions [8][9][10] .…”

Section: Introductionmentioning

confidence: 99%

Early versus late pancreatic stent placement for preventing post-ERCP pancreatitis: protocol of a multicentre randomised clinical trial

Wang,

Bai,

hong

et al. 2024

Preprint

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Background:Pancreatic stenting has been shown to effectively lower the occurrence of post-ERCP pancreatitis (PEP) and reduce its severity. To date, no evidence exists to determine the optimal timing for pancreatic stent placement in prospective trials. Our aim is to compare early versus late pancreatic stent placement in preventing PEP among patients with naive papilla. Methods/Design: The EVL (Early stenting vs. Late stenting) trial is a multi-centre, single-blind, randomized, and controlled trial. All patients with difficult biliary cannulation undergoing endoscopic retrograde cholangiopancreatography (ERCP) with pancreatic guidewire-assisted technique for biliary access will be told about the opportunity to participate in EVL research. In total, 768 patients will be randomly assigned (1:1) to two arms: (1) early pancreatic stent placement (EPSP) (a pancreatic stent will be placed immediately after endoscopic retrograde cholangiography (ERC) or endoscopic sphincterotomy (EST)) and (2) late pancreatic stent placement (LPSP) (a pancreatic stent will be placed after all completion of therapeutic biliary procedures, e.g. biliary stone removal or drainage). The primary outcome is the rate and severity of PEP. The secondary outcomes are hyperamylasemia, the rate of stenting success, and other ERCP-related adverse events (AEs). Discussion: The EVL trial will provide essential answers regarding the optimal timing of prophylactic pancreatic stent placement in PEP prevention. Our findings could change ERCP outcomes and practices. Trial registration: ClinicalTrials.govNCT06250803. Registered on February 9, 2024.

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Incidence, severity, and mortality of post-ERCP pancreatitis: an updated systematic review and meta-analysis of 145 randomized controlled trials

Cited by 37 publications

References 128 publications

Prediction for post-ERCP pancreatitis in non-elderly patients with common bile duct stones: a cross-sectional study at a major Chinese tertiary hospital (2015–2023)

Prediction for post-ERCP pancreatitis in non-elderly patients with common bile duct stones: a cross-sectional study at a major Chinese tertiary hospital (2015–2023)

Utility of interventional endoscopic ultrasound in pancreatic cancer

Early versus late pancreatic stent placement for preventing post-ERCP pancreatitis: protocol of a multicentre randomised clinical trial

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