IDDF2020-ABS-0101 Impact of optimal timing of early precut sphincterotomy on the risk of endoscopic retrograde cholangiopancreatography related adverse events: a systematic review and meta-analysis
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Résumé
<h3>Background</h3> Endoscopic retrograde cholangiopancreatography (ERCP) has become an invaluable procedure in the management of pancreaticobiliary disorders. Selective cannulation of the common bile duct (CBD) is a prerequisite for successful therapeutic ERCP; however, it may fail in 5–20% of cases even in experienced endoscopists. Precut sphincterotomy is a technique done to gain access to the CBD when standard methods have failed. Needle-knife precutting is the most widely used method and has been reported to improve cannulation success rates. Some studies have demonstrated high rates of complications associated with this technique; while recent data confirmed that the impact of precut sphincterotomy depends on timing. <h3>Methods</h3> We conducted this meta-analysis to investigate whether early precut sphincterotomy is associated with increased risk of procedure-related adverse events (PRAE) compared with persistent cannulation. We also aim to determine the optimal timing of precut to prevent post-ERCP pancreatitis (PEP). A systematic search on four online databases was done. Studies were validated using the Cochrane risk-of-bias assessment tool and the Newcastle-Ottawa scale. Results were analyzed using the Cochrane Review Manager v5.3. The primary endpoints were the overall incidence of PEP and optimal time for precut sphincterotomy. Secondary outcomes were overall PRAE rate and success rate of biliary cannulation. <h3>Results</h3> Nine RCTs and 1 cohort (1,571 of 14,017 screened patients) were included in this meta-analysis. Pooled incidence showed a statistically significant decreased rates of PEP with early precut sphincterotomy (4.3%) compared with persistent cannulation (7.5%) (RR 0.60; 95% CI 0.39–0.92). Using a random-effects model, test for heterogeneity showed an I2 = 0% and Chi2 = 5.97. Subgroup analysis stratified based on the timing of precut showed that performing precut sphincterotomy at 5–10 minutes from initial cannulation has significantly lower rates of PEP (RR 0.50; 95% CI 0.26–0.94). <h3>Conclusions</h3> This meta-analysis suggests that compared with persistent cannulation, early precut sphincterotomy was associated with a significantly decreased risk of developing PEP. In addition, subgroup analysis showed that performing precut after 5 minutes, but not exceeding 10 minutes after failed biliary cannulation, has the benefit of having 50% less risk of developing PEP.(Figure 1)
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Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,010 | 0,008 |
| Bibliométrie | 0,001 | 0,002 |
| 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 | 0,001 |
| 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.
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