Lack of consensus on the role of endoscopic retrograde cholangiography in acute biliary pancreatitis in published meta-analyses and guidelines: a systematic review

Abstract

Objectives: Several randomized controlled trials studied the role of endoscopic retrograde cholangiopancreaticography (ERCP) and endoscopic sphincterotomy (ES) in acute biliary pancreatitis (ABP). No study assessed whether these trials resulted in international consensus in published meta-analyses and treatment guidelines.

Methods: A systematic review, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, of meta-analyses and guidelines on ERCP in ABP was performed in PubMed until August 2011.The methodological quality of the meta-analysis and guidelines was assessed by a validated quality assessment tool.

Results: Eight meta-analyses and 12 guidelines fulfilled the inclusion criteria. There is consensus that ERCP is indicated in case of ABP with coexistent cholangitis and/or persistent cholestasis. By exception of the first meta-analysis, all included studies disapproved early ERCP in predicted mild ABP. Consensus is lacking regarding the role of early ERCP in predicted severe ABP, as 3 meta-analyses and 1 guideline do not advice this strategy. Routine early ERCP in predicted severe ABP is recommended in 7 of the 11 guidelines.

Conclusions: There is consensus in guidelines and meta-analyses that ERCP/ES is indicated in patients with ABP and coexisting cholangitis and/or persistent cholestasis. Consensus is lacking on the role of routine early ERCP/ES in patients with predicted severe ABP.