A Cochrane review [Abstract] 1 [withdrawn from publication] included three studies, with a total of 511 subjects, on early endoscopic retrograde cholangio-pancreatography (within 72 hours of admission) with or without endoscopic sphincterotomy (ERCP+/-ES) in patients with a severe attack of gallstone-associated acute pancreatitis (GAP).
Fixed effect and random effect meta-analyses gave identical results. Early ERCP +/- ES was associated with non-significant effect on reduction of mortality in predicted mild (OR = 0.62, 95% CI = 0.27 to 1.41) and severe GAP (OR = 0.62, 95% CI = 0.27 to 1.41). Reduction in complications was non-significant in predicted mild (OR = 0.89, 95% CI = 0.53 to 1.49), but significant in severe GAP (OR = 0.27, 95% CI = 0.14 to 0.53). These results are controlled for confounding due to associated acute cholangitis and are robust for clinical and statistical heterogeneity. There was insufficient evidence to draw any conclusions about hospital stay and cost.
Comment: The quality of evidence is downgraded by imprecise results (limited study size for each comparison).
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