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
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.003 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".