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Article: Does early ERCP ± ES reduce the morbidity and mortality of acute gallstone pancreatitis? A meta-analysis

TitleDoes early ERCP ± ES reduce the morbidity and mortality of acute gallstone pancreatitis? A meta-analysis
Authors
Issue Date1998
PublisherMosby, Inc. The Journal's web site is located at http://www.elsevier.com/locate/gie
Citation
Gastrointestinal Endoscopy, 1998, v. 47 n. 4, p. AB130 How to Cite?
AbstractThere are conflicting reports concerning the benefits of early endoscopic retrograde cholangiography (ERCP) with endoscopic sphincterotomy (ES) in patients with acute gallstone pancreatitis (AGP). The issue of whether or not to perform early ERCP ± ES is of clinical importance because AGP is associated with significant morbidity and mortality. Aim: To determine if early ERCP with or without ES reduces the morbidity and mortality of patients with AGP. Methods: Using MEDLINE and manual searches, we identified four randomized controlled trials that compared the use of early ERCP ± ES to conservative therapy in patients with pancreatitis. We contacted authors to provide data of patients with AGP and stratified the results based on the severity of pancreatitis, as determined by the early predictors. We used odds ratios (ORs) of the morbidity and mortality, and the Mantel-Haenszel method. Results: Of the 838 patients included in the four studies performed in four countries - 695 patients had AGP and were randomized to early ERCP ± ES versus conservative therapy. The common OR estimators showed that early ERCP ± ES reduced the morbidity and mortality of patients with AGP versus conservative treatment, especially in patients who were predicted to have severe pancreatitis. Prognosis Outcomes Odds Ratio (95% CI) Mild Morbidity 0.66(0.42- 1.03) Mild Mortality 0.60(0.16- 2.30) Severe Morbidity 0.27(0.15- 0.48) Severe Mortality 0.37(0.16- 0.85) All grades Morbidity 0.51 (0.36- 0.70) All grades Mortality 0.44 (0.23-0.87)*Lower OR favors use of early ERCP ± ES.*Heterogeneity was present. Conclusion: Early ERCP with or without ES reduces the morbidity and mortality of patients with AGP, especially in patients who were predicted, by the early prognostic indices, to have severe pancreatitis.
Persistent Identifierhttp://hdl.handle.net/10722/172965
ISSN
2015 Impact Factor: 6.217
2015 SCImago Journal Rankings: 2.390

 

DC FieldValueLanguage
dc.contributor.authorSoetikno, RMen_US
dc.contributor.authorCarrLocke, DLen_US
dc.contributor.authorNeoptolemos, JPen_US
dc.contributor.authorFan, STen_US
dc.contributor.authorFoelsch, Uen_US
dc.contributor.authorMarek, TAen_US
dc.contributor.authorNowak, Aen_US
dc.date.accessioned2012-10-30T06:26:05Z-
dc.date.available2012-10-30T06:26:05Z-
dc.date.issued1998en_US
dc.identifier.citationGastrointestinal Endoscopy, 1998, v. 47 n. 4, p. AB130en_US
dc.identifier.issn0016-5107en_US
dc.identifier.urihttp://hdl.handle.net/10722/172965-
dc.description.abstractThere are conflicting reports concerning the benefits of early endoscopic retrograde cholangiography (ERCP) with endoscopic sphincterotomy (ES) in patients with acute gallstone pancreatitis (AGP). The issue of whether or not to perform early ERCP ± ES is of clinical importance because AGP is associated with significant morbidity and mortality. Aim: To determine if early ERCP with or without ES reduces the morbidity and mortality of patients with AGP. Methods: Using MEDLINE and manual searches, we identified four randomized controlled trials that compared the use of early ERCP ± ES to conservative therapy in patients with pancreatitis. We contacted authors to provide data of patients with AGP and stratified the results based on the severity of pancreatitis, as determined by the early predictors. We used odds ratios (ORs) of the morbidity and mortality, and the Mantel-Haenszel method. Results: Of the 838 patients included in the four studies performed in four countries - 695 patients had AGP and were randomized to early ERCP ± ES versus conservative therapy. The common OR estimators showed that early ERCP ± ES reduced the morbidity and mortality of patients with AGP versus conservative treatment, especially in patients who were predicted to have severe pancreatitis. Prognosis Outcomes Odds Ratio (95% CI) Mild Morbidity 0.66(0.42- 1.03) Mild Mortality 0.60(0.16- 2.30) Severe Morbidity 0.27(0.15- 0.48) Severe Mortality 0.37(0.16- 0.85) All grades Morbidity 0.51 (0.36- 0.70) All grades Mortality 0.44 (0.23-0.87)*Lower OR favors use of early ERCP ± ES.*Heterogeneity was present. Conclusion: Early ERCP with or without ES reduces the morbidity and mortality of patients with AGP, especially in patients who were predicted, by the early prognostic indices, to have severe pancreatitis.en_US
dc.languageengen_US
dc.publisherMosby, Inc. The Journal's web site is located at http://www.elsevier.com/locate/gieen_US
dc.relation.ispartofGastrointestinal Endoscopyen_US
dc.titleDoes early ERCP ± ES reduce the morbidity and mortality of acute gallstone pancreatitis? A meta-analysisen_US
dc.typeArticleen_US
dc.identifier.emailFan, ST: stfan@hku.hken_US
dc.identifier.authorityFan, ST=rp00355en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.scopuseid_2-s2.0-4243684285en_US
dc.identifier.volume47en_US
dc.identifier.issue4en_US
dc.identifier.spageAB130en_US
dc.publisher.placeUnited Statesen_US
dc.identifier.scopusauthoridSoetikno, RM=7003663894en_US
dc.identifier.scopusauthoridCarrLocke, DL=7005213966en_US
dc.identifier.scopusauthoridNeoptolemos, JP=7102231480en_US
dc.identifier.scopusauthoridFan, ST=7402678224en_US
dc.identifier.scopusauthoridFoelsch, U=15732665900en_US
dc.identifier.scopusauthoridMarek, TA=7005675889en_US
dc.identifier.scopusauthoridNowak, A=7201664999en_US

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