Early ERCP in acute gallstone pancreatitis without cholangitis: a meta-analysis.

CONTEXT: Early ERCP was reported to result in recovery from acute gallstone pancreatitis. To date, several RCTs comparing it to conservative treatment have yielded different results.

OBJECTIVE: We conducted a meta-analysis to determine the effect of early ERCP on the morbidity and mortality of acute gallstone pancreatitis without cholangitis.

METHODS: We searched the following databases up to January 11(th), 2008: the Cochrane Library, MEDLINE, EMBASE, the Australasian Medical Index, Latin American Caribbean Health Sciences Literature, and the Health Research and Development Information Network. References were scrutinized. Authors were contacted. There were no restrictions regarding language, publication date or publication status.

RESULTS: Seven RCTs were retrieved, but only two RCTs involving 177 treated patients and 163 control patients were included. A meta-analysis on morbidity was inconclusive (RR=0.95, 95% CI: 0.74-1.22). Meta-analysis on mortality only showed a trend in favor of conservative management (RR=1.92, 95% CI: 0.86-4.32) for both mild and severe pancreatitis.

CONCLUSIONS: There is a trend towards more mortality from early ERCP with or without sphincterotomy in the setting of acute gallstone pancreatitis without cholangitis. However, more studies are needed. In the meantime, early ERCP should not be carried out unless there is at least a slight suspicion of cholangitis or persistent ampullary obstruction.