Author(s): Ding X, Zhang F, Wang Y
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Abstract BACKGROUND AND AIM: Pancreatitis is the most common and serious complication of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP). Prevention strategies targeting risk factors could be important to reduce the rate of post-ERCP pancreatitis. However, the risk factors for post-ERCP pancreatitis (PEP) are still debated. This systematic review and meta-analysis was performed to identify risk factors for PEP. METHODS: Medline (PubMed and Ovid), Cochrane Central Register of Controlled trials & Database of Systematic Reviews, Embase, Scopus, ScienceDirect, Springer links and WEB OF SCIENCE were searched for published studies in all languages. Inclusion and exclusion criteria were defined a priori. Eighteen probable risk factors were evaluated, and outcomes were expressed in the case of dichotomous variables, as an odds ratio (OR) (with a 95\% confidence interval, (CI)). RESULTS: When patient-related risk factors were analyzed, the ORs for female gender was 1.46 (95\%CI: 1.30-1.64); for previous pancreatitis 2.03 (95\%CI: 1.31-3.14); for previous PEP was 2.90 (95\%CI: 1.87-4.48); for Sphincter of Oddi dysfunction (SOD) was 2.04 (95\%CI: 1.73-2.33) and for Intraductal papillary mucinous neoplasm (IPMN) was 3.01 (95\%CI: 1.34-6.77). Four endoscopy-related factors were confirmed: the OR for difficult cannulation was 3.49 (95\%CI: 1.364-8.925); for endoscopic sphincterotomy (EST) it was 1.39 (95\%CI: 1.09-1.79); for precut sphincterotomy it was 2.25 (95\%CI: 1.70_2.96); and for main pancreatic duct injection it was 1.58 (95\%CI: 1.21-2.08). CONCLUSIONS: Female gender, previous pancreatitis, previous PEP, SOD, IPMN, difficult cannulation, EST, precut sphincterotomy and main pancreatic duct injection are risk factors for post-ERCP pancreatitis. Copyright © 2014 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.
This article was published in Surgeon
and referenced in Journal of Anesthesia & Clinical Research