Adverse Events Associated with Endoscopic Retrograde Cholangiopancreatography: Systematic Review and Meta-analysis

IF 25.7 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gastroenterology Pub Date : 2024-11-07 DOI:10.1053/j.gastro.2024.10.033

Kirles Bishay, Zhao Wu Meng, Rishad Khan, Mehul Gupta, Yibing Ruan, Marcus Vaska, Jordan Iannuzzi, Dylan E. O’Sullivan, Brittany Mah, Arun C.R. Partridge, Amanda M. Henderson, Howard Guo, Sunil Samnani, Max DeMarco, Yuhong Yuan, B. Joseph Elmunzer, Rajesh N. Keswani, Sachin Wani, Zachary L. Smith, Ronald J. Bridges, Nauzer Forbes

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引用次数: 0

Abstract

Background & Aims

Endoscopic retrograde cholangiopancreatography (ERCP)-related adverse events (AEs) are associated with morbidity, mortality, and healthcare expenditure. We aimed to assess incidences and comparisons of ERCP AEs.

Methods

We included studies performed after 2000 reporting on ERCP AEs from database inception through March 12, 2024. Outcomes included pancreatitis, bleeding, cholangitis, cholecystitis, perforation, and death. DerSimonian and Laird random effects meta-analyses were performed to calculate incidences of AEs. Subgroup and pairwise meta-analyses were performed. Meta-regression was performed on median recruitment year to assess temporal trends in pancreatitis incidence.

Results

A total of 380 studies were included. The incidence of death attributable to ERCP was 0.2% (95% confidence intervals, CI, 0.1-0.3%, I² 44%, n=47,258) in all-comers. The overall incidence of pancreatitis was 4.6% (95% CI 4.0-5.1%, I² 96%, n=293,378) among all-comers and 6.5% (95% CI 5.9-7.1%, I² 89%, n=88,809) among first-time patients. Pancreatitis incidence remained stable between 2000-2023 (average annual percent change 0.06, 95%CI -0.27 to 0.39). The overall incidences of the following AEs for all-comers were: bleeding (1.5%, 95% CI 1.2-1.7%, I² 93%, n=229,655), cholangitis (2.5%, 95%CI 1.9-3.3%, I² 96%, n=121,619), cholecystitis (0.8%, 95%CI 0.5-1.2%, I² 39%, n=7,799), and perforation (0.5%, 95%CI 0.4-0.6%, I² 90%, n=306,378).

Conclusions

ERCP-associated AEs remain common. Incidence of post-ERCP pancreatitis remained static despite improvements in techniques, prevention, and recognition. These results are important to patients, endoscopists, and policy makers to inform consent and to encourage implementation of available risk mitigation strategies.

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与内镜逆行胰胆管造影术相关的不良事件：系统回顾和元分析

背景& 目的内镜逆行胰胆管造影术（ERCP）相关不良事件（AEs）与发病率、死亡率和医疗支出相关。我们旨在评估 ERCP AEs 的发生率并进行比较。方法我们纳入了 2000 年后进行的研究，这些研究报告了从数据库建立到 2024 年 3 月 12 日期间发生的 ERCP AEs。结果包括胰腺炎、出血、胆管炎、胆囊炎、穿孔和死亡。采用 DerSimonian 和 Laird 随机效应荟萃分析来计算 AE 的发生率。还进行了分组和配对荟萃分析。对中位招募年份进行了元回归，以评估胰腺炎发病率的时间趋势。在所有参与者中，ERCP导致的死亡发生率为0.2%（95%置信区间，CI，0.1-0.3%，I2 44%，n=47,258）。在所有患者中，胰腺炎的总发病率为 4.6% (95% CI 4.0-5.1%, I2 96%, n=293,378)，而在首次就诊的患者中，胰腺炎的总发病率为 6.5% (95% CI 5.9-7.1%, I2 89%, n=88,809)。2000-2023 年间，胰腺炎发病率保持稳定（年均百分比变化为 0.06，95%CI -0.27 至 0.39）。在所有患者中，以下 AEs 的总发生率为：出血（1.5%，95%CI 1.2-1.7%，I2 93%，n=229,655）、胆管炎（2.5%，95%CI 1.9-3。3%，I2 96%，n=121,619）、胆囊炎（0.8%，95%CI 0.5-1.2%，I2 39%，n=7,799）和穿孔（0.5%，95%CI 0.4-0.6%，I2 90%，n=306,378）。尽管在技术、预防和识别方面有所改进，但ERCP术后胰腺炎的发生率仍保持不变。这些结果对于患者、内镜医师和政策制定者来说非常重要，可为同意提供信息并鼓励实施现有的风险缓解策略。

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来源期刊

Gastroenterology 医学-胃肠肝病学

CiteScore

45.60

自引率

2.40%

发文量

4366

审稿时长

26 days

期刊介绍： Gastroenterology is the most prominent journal in the field of gastrointestinal disease. It is the flagship journal of the American Gastroenterological Association and delivers authoritative coverage of clinical, translational, and basic studies of all aspects of the digestive system, including the liver and pancreas, as well as nutrition. Some regular features of Gastroenterology include original research studies by leading authorities, comprehensive reviews and perspectives on important topics in adult and pediatric gastroenterology and hepatology. The journal also includes features such as editorials, correspondence, and commentaries, as well as special sections like "Mentoring, Education and Training Corner," "Diversity, Equity and Inclusion in GI," "Gastro Digest," "Gastro Curbside Consult," and "Gastro Grand Rounds." Gastroenterology also provides digital media materials such as videos and "GI Rapid Reel" animations. It is abstracted and indexed in various databases including Scopus, Biological Abstracts, Current Contents, Embase, Nutrition Abstracts, Chemical Abstracts, Current Awareness in Biological Sciences, PubMed/Medline, and the Science Citation Index.