SUNY Downstate Health Sciences University Brooklyn, NY, United States
Bhesh R. Karki, MD1, Pravash Budhathoki, MD2, Dhan B. Shrestha, MD3, Yub Raj Sedhai, MD4, Anurag Adhikari, MBBS5, Ayusha Poudel, MBBS6, Barun Aryal, MBBS7, Tul M. Gurung, MBBS8, Binod Karki, MBBS7, Dhruvan Patel, MD9 1SUNY Downstate Health Sciences University, Brooklyn, NY; 2BronxCare Health System, Bronx, NY; 3Mount Sinai Hospital, Chicago, IL; 4Virginia Commonwealth University School of Medicine, Richmond, VA; 5Nepal National Hospital, Kathmandu, Bagmati, Nepal; 6Alka Hospital, Kathmandu, Bagmati, Nepal; 7Nepalese Army Institute of Health Sciences, Kathmandu, Bagmati, Nepal; 8Nepal Medical College, Kathmandu, Bagmati, Nepal; 9Mercy Catholic Medical Center, Darby, PA
Introduction: Acute pancreatitis is a common gastroenterological emergency that can be fatal especially in severe cases. Frequently, patients with acute biliary pancreatitis (ABP) are treated by ERCP. Although there is a common consensus for ERCP in patients with cholangitis, data supporting routine ERCP in patients with ABP without cholangitis is insufficient. This meta-analysis aims to study the outcomes of urgent ERCP vs. conventional approach in ABP without cholangitis.
Methods: The study was conducted as per PRISMA guidelines. Literatures published from inception to December 2020 were searched using appropriate search words in Scopus, Embase, PubMed, PubMed Central, and Clinicaltrials.gov. The intervention group included patients with ABP who received ERCP within 72 hours and the control group included patients who were managed conservatively. The primary outcome was in-hospital mortality and secondary outcomes were rates of systemic and local complications (new-onset organ failure, ICU admission, pneumonia, pancreatic necrosis, and pseudocyst). The extracted data were analyzed using RevMan 5.4; outcomes were estimated with Odds Ratio.
Results: After a thorough screening of 2700 studies from initial database search, 4 fulfilled the inclusion criteria and were included in the meta-analysis. The mortality was slightly lower in the ERCP group, but it was not statistically significant (OR, 0.59; CI, 0.32-1.09; p=0.09, n=595). None of the secondary outcomes were significant: new-onset organ failure (OR, 1.06; CI, 0.65-1.75; p=0.81), ICU admission (OR, 1.64; CI, 0.97-2.77; p=0.06), pneumonia (OR, 0.81; CI, 0.40-1.65; p=0.56), pancreatic necrosis (OR, 0.80; CI, 0.49-1.32; p=0.38) and pancreatic pseudo-cyst (OR, 0.44; CI, 0.16-1.24; p=0.12).
Discussion: Unlike prior meta-analyses, our study included patients without concomitant cholangitis and early ERCP within 72 hours along with the new largest ERCP trial from Schepers et al. Our finding of no significant difference in mortality among the 2 studied groups were similar to meta-analyses by Petrol et al. and Morreti et al. Additionally, none of the evaluated secondary outcomes were statistically significant. We are thus in agreement with the European and American society of gastroenterology guidelines to avoid ERCP in the absence of cholangitis and biliary obstruction. Few major limitations included patients with varying severity of pancreatitis and cholestasis and inconsistent criteria for cholangitis among the included studies in our meta-analysis.
Figure: Forest plot comparing mortality outcome across urgent ERCP and conventional approach for acute biliary pancreatitis without cholangitis
Disclosures: Bhesh Karki indicated no relevant financial relationships. Pravash Budhathoki indicated no relevant financial relationships. Dhan Shrestha indicated no relevant financial relationships. Yub Raj Sedhai indicated no relevant financial relationships. Anurag Adhikari indicated no relevant financial relationships. Ayusha Poudel indicated no relevant financial relationships. Barun Aryal indicated no relevant financial relationships. Tul Gurung indicated no relevant financial relationships. Binod Karki indicated no relevant financial relationships. Dhruvan Patel: Olympus – Consultant. Shield Pharmaceuticals – Advisory Committee/Board Member.
Bhesh R. Karki, MD1, Pravash Budhathoki, MD2, Dhan B. Shrestha, MD3, Yub Raj Sedhai, MD4, Anurag Adhikari, MBBS5, Ayusha Poudel, MBBS6, Barun Aryal, MBBS7, Tul M. Gurung, MBBS8, Binod Karki, MBBS7, Dhruvan Patel, MD9. P1067 - A Systematic Review and Meta-analysis on Urgent ERCP vs. Conventional Approach in Acute Biliary Pancreatitis Without Cholangitis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.