Does endoscopic retrograde cholangiopancreatography reduce the risk of local pancreatic complications in acute pancreatitis? A systematic review and metaanalysis

Recent studies have added to the controversy regarding the role of endoscopic retrograde cholangiopancreatography (ERCP) in the management of patients with acute biliary pancreatitis. This debate is due in part to a marked difference between the trials regarding the definition of “complication” as an outcome. This study sought to determine the effect of early ERCP versus conservative treatment on local pancreatic complications (defined by the current classification) experienced by patients with acute biliary pancreatitis. Electronic databases (Cochrane Central Register of Controlled Trials, MEDLINE, Science Citation Index) and conference proceedings were searched for relevant randomized controlled trials up to December 2007. The effect of both treatment strategies on local pancreatic complications was calculated with random-effects models. Five trials involving 717 patients were included in this systematic review. Pooled analysis of all the patients with acute pancreatitis did not demonstrate a statistically significant difference between the two treatment strategies (relative risk [RR], 0.94; 95% confidence interval [CI], 0.63–1.40; p = 0.62). Similar results were observed after subgroup analysis based on the severity of disease as follows: mild acute pancreatitis (RR, 0.79; 95% CI, 0.26–2.47; p = 0.69); severe acute pancreatitis (RR, 0.77; 95% CI, 0.30–1.98; p = 0.59). The early use of ERCP did not result in a significantly reduced risk of local pancreatic complications for either patients with mild acute pancreatitis or those with severe form of the disease.