S1216 Is Endoscopic Bile Duct Stenting a Risk Factor for Post-ERCP Pancreatitis? A Systematic Review and Meta-Analysis
Notice bibliographique
Résumé
Introduction: Placement of a stent in the bile duct could potentially block pancreatic duct orifice, which may result in post-ERCP pancreatitis (PEP). Although bile duct stenting is the most commonly performed intervention during ERCP, its association with the development of PEP has been examined less frequently. Additionally, the results of association of PEP with bile duct stenting are inconsistent in these studies. The aim of this meta-analysis is to evaluate the risk of PEP with the placement of biliary stent. Methods: A literature search of several electronic databases was performed for all the published studies reporting the association of bile duct stenting and PEP. The Inverse Variance method was used to pool data of PEP outcomes in a random effects model. Odds ratio (OR) was used to generate an overall effect estimate of the outcome. Association of PEP with bile duct stenting was calculated separately for pooled univariable OR values as well as pooled multiple-logistic regression OR values. Publication bias was assessed by contour funnel plot and heterogeneity was calculated by I2 test. Methodological quality of the studies was assessed by Newcastle-Ottawa scale. Results: We identified 30 studies (7 prospective and 23 retrospective) with a total of 820,325 patients in the meta-analysis. Of these patients, 205,521 underwent endoscopic biliary stenting. The incidence of PEP varied from 1.2-10.8%. Bile duct stenting was included in multi-variate model in 20 of 30 studies and OR was reported in 18 of these studies. Pooled OR with 95% confidence interval (CI) by univariate analysis showed an increase in the risk of PEP with placement of bile duct stent (OR=1.61;CI:1.06, 2.46), Cochran Q test P< 0.00001. I2=98% (Figure 1A). Pooled OR by multi-variate analysis also showed a higher risk of PEP with biliary stenting (Figure 1B). Sensitivity analysis was performed after excluding studies where International Statistical Classification of Diseases and related Health Problems (ICD) codes were used for identifying PEP which revealed a pooled adjusted OR of 2.12 (95% CI 1.48, 3.02), Cochran’s Q test P< 0.0001, I2= 69%. Funnel plot appeared asymmetric, however Duval and Tweedie’s random effects model did not reveal any trimmed studies. Only 2 studies were moderate quality, while other studies were high quality per Newcastle-Ottawa assessment scale. Conclusion: Bile duct stenting is associated with a modest increase in the risk of post-ERCP pancreatitis.Figure 1.: A) Pooled Odds Ratio (OR) with 95% confidence interval (CI) by univariate analysis. B) Pooled OR by multi-variate analysis with corresponding CI.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,014 | 0,034 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,018 | 0,034 |
| Bibliométrie | 0,009 | 0,009 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,004 | 0,002 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,003 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 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 source (Gemma direct ou Codex distillé), 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 ».