Early Routine Endoscopic Retrograde Cholangiopancreatography (ERCP) Strategy versus Early Conservative Management Strategy in Acute Gallstone Pancreatitis: A Cochrane Systematic Review and Meta-analysis Presidential Poster
Notice bibliographique
Résumé
Purpose: The role and timing of ERCP in acute gallstone pancreatitis (AGP) remains controversial. To assess the effect of early routine ERCP strategy versus early conservative management strategy in patients with AGP. Methods: We conducted a meta-analysis of randomized controlled trials (RCTs) assessing the clinical effectiveness and safety of early routine ERCP strategy compared to early conservative management strategy. We searched CENTRAL, MEDLINE, EMBASE and LILACS databases and major conference proceedings up to January 2012 with no language restriction. RCTs comparing early routine ERCP strategy versus early conservative management with or without selective use of ERCP strategy in patients with AGP were included. Study selection, data extraction and methodological quality assessment using the risk of bias instrument were conducted independently by two authors. Primary outcome was mortality. Secondary outcomes included local and systemic complications as defined by the Atlanta Classification and ERCP related complications. Revman 5.1 was used to calculate pooled risk ratios (RR) with 95% confidence intervals (Mandel-Haenszel method; random effects model). Heterogeneity was assessed by Chi2 test (P<0.10) and I2 test (>50%). To explore possible sources of heterogeneity, a priori subgroup analyses were conducted. Results: Seven RCTs were included: five in the main analyses and an additional two (comprising only of patients with severe pancreatitis) only in subgroup analyses. There were no significant differences between the two strategies in mortality (risk ratio [RR] 0.74; 95% CI 0.18 to 3.03), local and systemic complications (RR 0.86; 95% CI 0.52 to 1.43; and RR 0.59; 95% CI 0.31 to 1.11) regardless of predicted severity. Among trials that included cholangitis, early routine ERCP strategy significantly reduced mortality (RR 0.20; 95% CI 0.06 to 0.68), local and systemic complications (RR 0.45; 95% CI 0.20 to 0.99; and RR 0.37; 95% CI 0.18 to 0.78). Among trials that included biliary obstruction, early routine ERCP strategy was associated with a non-significant trend towards reduction of local and systemic complications (RR 0.53; 95% CI 0.26 to 1.07; and RR 0.56; 95% CI 0.30 to 1.02). ERCP complications were infrequent. Conclusion: In patients with AGP, there is no evidence that early routine ERCP significantly affects mortality, and local or systemic complications of pancreatitis regardless of predicted severity. Our results, however, provide support for current recommendations that early ERCP should be considered in patients with co-existing cholangitis or biliary obstruction.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,003 | 0,001 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».