Meta-Analysis
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World J Gastroenterol. Apr 14, 2014; 20(14): 4093-4101
Published online Apr 14, 2014. doi: 10.3748/wjg.v20.i14.4093
Effect of precut sphincterotomy on post-endoscopic retrograde cholangiopancreatography pancreatitis: A systematic review and meta-analysis
Abhishek Choudhary, Jessica Winn, Sameer Siddique, Murtaza Arif, Zainab Arif, Ghassan M Hammoud, Srinivas R Puli, Jamal A Ibdah, Matthew L Bechtold
Abhishek Choudhary, Jessica Winn, Sameer Siddique, Murtaza Arif, Zainab Arif, Ghassan M Hammoud, Jamal A Ibdah, Matthew L Bechtold, Division of Gastroenterology, Department of Internal Medicine, University of Missouri-Columbia, M580 Health Sciences Center, Columbia, MO 65212, United States
Srinivas R Puli, Division of Gastroenterology and Hepatology, University of Illinois, Peoria Campus, OSF Saint Francis Medical Center, Peoria, IL 61637, United States
Author contributions: Choudhary A, Winn J and Bechtold ML designed research; Choudhary A, Winn J, Arif Z, Siddique S and Arif M performed research; Puli SR, Hammoud GM and Ibdah JA contributed with analytic tools; Choudhary A, Bechtold ML and Puli SR analyzed data; Choudhary A, Arif M and Bechtold ML wrote the paper.
Correspondence to: Abhishek Choudhary, MD, Assistant Professor, Division of Gastroenterology, Department of Internal Medicine, University of Missouri-Columbia, M580 Health Sciences Center, DC043.00, Five Hospital Drive, Columbia, MO 65212, United States. choudharya@health.missouri.edu
Telephone: +1-573-8827349 Fax: +1-573-8844595
Received: October 18, 2013
Revised: December 27, 2013
Accepted: January 14, 2014
Published online: April 14, 2014
Abstract

AIM: To conduct a systemic review and meta-analysis to investigate the role of early precut technique. Multiple randomized controlled trails (RCTs) have reported conflicting results of the early precut sphincterotomy.

METHODS: MEDLINE/PubMed, EMBASE, Cochrane Central Register of Controlled Trials and Database of Systematic Reviews, and recent abstracts from major conference proceedings were searched (June 2013). Randomized and non-randomized studies comparing early precut technique with prolonged standard methods were included. Pooled estimates of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP), cannulation and adverse events were analyzed by using odds ratio (OR). Random and fixed effects models were used as appropriate. Publication bias was assessed by funnel plots. Heterogeneity among studies was assessed by calculating I2 measure of inconsistency.

RESULTS: Seven randomized and seven non-randomized trials met inclusion criteria. Meta-analysis of RCTs showed a decrease trend for PEP with early precut sphincterotomy but was not statistically significant (OR = 0.58; 95%CI: 0.32-1.05; P = 0.07). No heterogeneity was noted among the studies with I2 of 0%.

CONCLUSION: Early precut technique for common bile duct cannulation decreases the trend of post-ERCP pancreatitis.

Keywords: Early precut, Endoscopic retrograde cholangiopancreatography cannulation, Post-endoscopic retrograde cholangiopancreatography pancreatitis, Randomized controlled trials, Meta-analysis

Core tip: Multiple trials are available in literature, but still the optimal timing of precut sphincterotomy is debatable. We conducted systemic review and meta-analysis to explore the effect of early precut sphincterotomy on post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis with emphasis on analysis of optimal timing of precut sphincterotomy. Our meta-analysis showed that early precut sphincterotomy decreases the odds of post-ERCP pancreatitis, particularly if done within 5-10 min of failed cannulation without compromising cannulation rates or increasing other complications.