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
Bibliographic record
Abstract
<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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.016 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.009 | 0.016 |
| Bibliometrics | 0.004 | 0.005 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.001 |
| Insufficient payload (model declined to judge) | 0.029 | 0.002 |
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 source (direct Gemma or distilled Codex), 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".