Meta-analysis of early Endoscopic Retrograde Cholangiopancreatograpy (ERCP) and Endoscopic Spincterotomy (ES) versus conservative treatment for acute Gallstone Pancreatitis (GSP)

OBJECTIVES: The aim was to conduct a meta-analysis of RCTs investigating the treatment of GSP by early ERCP ± ES versus conservative management and analyzing the patient outcomes. DATA SOURCES: A search of Medline, Embase, Science Citation Index, Current Contents, PubMed and the Cochrane Database of Systematic Reviews identified all RCTs comparing early ERCP to conservative management in gallstone pancreatitis published between January 1970 and January 2014. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS & INTERVENTIONS: Only prospective RCTs comparing early intervention (i.e. between 24 and 72 hours) with ERCP ± ES versus conservative management in GSP were included. STUDY APPRASIAL AND SYNTHESIS METHODS: Variables analyzed included overall mortality, overall morbidity, severity of pancreatitis (mild or severe), pseudocyst formation, organ failure (renal, respiratory and cardiac), abnormal coagulation, biliary sepsis and development of pancreatic abscess/phlegmon. RESULTS: Eleven RCTs consisting of 1314 patients (conservative management = 662, ERCP= 652) were analyzed. There was a near significant decrease in mortality comparing ERCP and conservatively managed patients with severe pancreatitis with overall complications significantly reduced in the ERCP group. In those with mild disease, a strong trend to decreased morbidity in the ERCP group was seen, but mortality was unaffected, Systemic (renal, cardiac, respiratory, coagulation abnormalities and biliary sepsis,), and local complications (pseudocyst and pancreatic abscess formation) were not significantly improved through early ERCP. CONCLUSIONS: This meta-analysis demonstrates a decrease in mortality with early ERCP ± ES versus conservative management in severe GSP, with a significant decrease in complications in this group.