Meta-Analysis
Copyright ©2014 Baishideng Publishing Group Co.
World J Gastroenterol. Apr 14, 2014; 20(14): 4093-4101
Published online Apr 14, 2014. doi: 10.3748/wjg.v20.i14.4093
Table 1 Quality analysis of included randomized trials
StudyYearCenterCountryType of RCTAllocation concealmentIntention to-treatJadad score
Cennamo et al[13]2009SingleItalyNon blindedAYes3
Tang et al[15]2005SingleCanadaNon blindedAYes3
Khatibian et al[14]2008SingleIranNon blindedBYes3
de Weerth et al[12]2006SingleGermanyNon blindedBYes3
Zhou et al[11]2006SingleChinaNon blindedBN/A2
Manes et al[10]2009MultiItalyNon blindedAYes3
Swan et al[16]2013SingleAustraliaNon blindedAN/A2
Table 2 Baseline patient characteristics of included trials
StudyPatients (n)
Age (year in mean)
Female
Malignant jaundice
CBD stone
SOD
EStdEStdEStdEStdEStdEStd
Cennamo et al[13]3611068171155.5%53.6%33.3%25.4%66.6%74.5%00
Tang et al[15]323064.667.253.1%53.3%34.3%33.3%21.9%13.3%3.1%6.7%
Khatibian et al[14]10611256.655.953.8%67%N/AN/A51.9%68.8%21.2%12.8%
de Weerth et al[12]145146666466%66%40%23%46.8%59.5%N/AN/A
Zhou et al[11]434862.764.339.5%39.5%30.2%25%20.9%22.9%N/AN/A
Manes et al[10]7774666535%35.1%33.7%40.5%53.2%41.9%02.7%
Swan et al[16]3934595772%66%N/AN/A10.3%17.6%5.1%8.8%
Table 3 Interventions in various trials and pancreatitis definitions
StudyPrecut timingTiming for std cannulationType of pre cutUse of GWPD stent/PPPEP criteriaFellow involvement
Cennamo et al[13]5 min of failed cannulation or 3 pancreatic duct cannulation20 min post randomizationPapillotomyYesNoConsensusNo
Criteria
Tang et al[15]12 min of failed cannulation15 min post randomizationPapillotomyNoNoConsensusYes
Criteria
Khatibian et al[14]Immediate precut15 min post randomizationFistulotomyYesNoConsensusNo
Criteria
de Weerth et al[12]Immediate precut20 min post randomization or 3 pancreatic cannulationPapillotomyYesN/AConsensusNo
Criteria
Zhou et al[11]10 min of failed cannulation or 3 pancreatic duct cannulationN/APapillotomy and fistulotomyYesN/AN/AN/A
Manes et al[10]10 min of failed cannulation or 5 pancreatic duct cannulation10 min post randomizationFistulotomyYesNoConsensusN/A
Criteria
Swan et al[16]5 min of failed cannulation or 2 pancreatic duct cannulation10 min post randomizationPapillotomyYesYes1ConsensusYes
Criteria
Table 4 Outcome of various studies
StudyPrimary cannulation rates
ITT
Overall complication
Pancreatitis
Cholangitis
Bleeding
Perforation
Need for second ERCP
EStdEStdEStdEStdEStdEStdEStdEStd
Cennamo et al[13]33/36104/11036/36110/1103/367/1101/366/110N/AN/A1/361/1101/360/1103/366/110
Tang et al[15]24/3222/3031/3228/304/323/302/322/301/320/301/320/300/320/300/321/30
Khatibian et al[14]88/106100/112105/106111/1123/1063/1122/1063/1120/1060/1120/1060/1121/1060/11218/10612/112
de Weerth et al[12]145/145145/146145/145146/1463/1455/1463/1454/146N/AN/A0/1451/1460/1450/1460/1451/146
Zhou et al[11]39/4336/48N/AN/A4/437/481/432/480/432/481/430/480/430/48N/AN/A
Manes et al[10]63/7766/7471/7771/7411/7716/742/7711/74N/AN/A5/772/740/741/7714/778/74
Swan et al[16]34/3929/34N/AN/A9/398/348/396/34N/AN/A1/392/340/390/34N/AN/A
Table 5 Subgroup and cumulative analysis for timing of precut sphincterotomy
Timing of precutORPvalue
Subgroup analysis
Immediate0.73; 95%CI: 0.23-2.330.59
5-10 min0.49; 95%CI: 0.23-1.040.07
5-12 min0.53; 95%CI: 0.26-1.070.08
Cumulative analysis
Immediate0.73; 95%CI: 0.23-2.330.59
Immediate and within 5 min0.85; 95%CI: 0.40-1.800.67
Immediate and within 10 min0.55; 95%CI: 0.29-1.030.06
Table 6 Odd’s ratio for outcomes
OutcomesORPvalue
Methods of precut
Fistulotomy0.27; 95%CI: 0.09-0.820.02
Papillotomy0.89; 95%CI: 0.41-1.920.77
Study quality
High quality study0.44; 95%CI: 0.21-0.930.03
Sample size > 1000.39; 95%CI: 0.17-0.890.02
Table 7 Summary of non-randomized studies
Study (lead author/year)CountryPublication typeMean ageFemalesPre cut applicationnPancreatitisP
EP Std methods
Giussani et al[17], 2008ItalyAbstractN/AN/A< 10 cannulation attempts8048.3%11.6%NS
Testoni et al[18], 2010ItalyArticleN/A50.20%< 10 cannulation attempts3087.6%15.4%NS
Xinopoulos et al[19], 2009N/AAbstractN/AN/AN/A1348.3%8.5%NS
Madacsy et al[20], 2009HungaryArticle5791%10 min of failed cannulation or 5 pancreatic duct cannulation570%42.8%< 0.05
Ayoubi et al[21], 2009ItalyAbstract68.6 (median)58.9%Immediate precut1731.1%5.8%NS
De La Mora-Levy et al[22], 2011MexicoAbstractN/AN/AImmediate precut6810.3%10.2%NS
Testoni et al[23], 2011ItalyArticleN/A49.7%< 10 cannulation attempts20043.3%14.3%< 0.05