Predictors of Post-endoscopic Retrograde Cholangiopancreatography Pancreatitis: A Comprehensive Systematic Review and Meta-analysis.

IF 11.6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
Azizullah Beran, Tarek Aboursheid, Adel Hajj Ali, Tarek Nayfeh, Hashem Albunni, Alejandra Vargas, Mouhand F Mohamed, Khaled Elfert, Mohammad Shaear, Ite Obaitan, Nasir Saleem, Awais Ahmed, Mark A Gromski, John M DeWitt, Mohammad Al-Haddad, James L Watkins, Evan Fogel, Jeffrey J Easler
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引用次数: 0

Abstract

Background & aims: Pancreatitis is the most common serious adverse event associated with endoscopic retrograde cholangiopancreatography (ERCP). This meta-analysis aimed to precisely assess the risk factors for post-ERCP pancreatitis (PEP).

Methods: We searched electronic databases for studies that assessed risk factors for PEP after adjusting for ≥3 risk factors, including at least one pre-specified patient-related and one procedure-related risk factor, and reported the data as adjusted odds ratios (ORs) with 95% confidence intervals. Meta-analyses were conducted using a random-effects model, and pooled adjusted ORs for risk factors reported in ≥3 studies were constructed.

Results: A total of 159 studies with 315,580 ERCPs were included, assessing 31 unique risk factors (20 patient-related and 11 procedure-related). Key patient-related predictors of PEP were age ≤60 years (OR, 1.81; high credibility), prior acute pancreatitis (OR, 2.59; moderate), age ≤40 years (OR, 2.33; moderate), asymptomatic choledocholithiasis (OR, 4.76; low), prior PEP (OR, 4.40; low), sphincter of Oddi dysfunction (OR, 3.11; low), and female gender (OR, 1.70; low). Key procedure-related predictors of PEP were any guidewire passage into the pancreatic duct (PD) (OR, 2.18; high), first ERCP with a native papilla (OR, 1.91; high), endoscopic papillary balloon dilation of an intact papilla (OR, 2.91; moderate), pancreatic acinarization (OR, 4.23; low), any PD cannulation (OR, 2.73; low), pancreatic sphincterotomy (OR, 2.64; low), difficult cannulation (OR, 2.60; low), any pancreatogram (OR, 2.40; low), and precut sphincterotomy (OR, 1.98; low).

Conclusions: Our meta-analysis focused on adjusted risk factors to provide precise estimates of the most important risk factors for PEP. Incorporating our results into a prediction model may reliably help identify high-risk patients, optimize informed consent, and guide prevention and management strategies for PEP.

ercp后胰腺炎的预测因素:一项全面的系统回顾和荟萃分析。
背景和目的:胰腺炎是内镜逆行胰胆管造影(ERCP)最常见的严重不良事件。本荟萃分析旨在准确评估ercp后胰腺炎(PEP)的危险因素。方法:我们检索电子数据库,在校正≥3个危险因素后评估PEP危险因素的研究,包括至少一个预先指定的与患者相关和一个与手术相关的危险因素,并以校正优势比(OR)(95%置信区间)报告数据。采用随机效应模型进行meta分析,并对≥3项研究中报告的危险因素进行汇总调整后的or。结果:共纳入159项研究,315,580个ercp,评估了31个独特的危险因素(20个与患者相关,11个与手术相关)。PEP的关键患者相关预测因子为年龄≤60岁(OR: 1.81,高可信度)、既往急性胰腺炎(OR: 2.59,中度)、年龄≤40(2.33,中度)、无症状胆石结石(4.76,低可信度)、既往PEP(4.40,低可信度)、Oddi括约肌功能障碍(3.11,低可信度)和女性(1.70,低可信度)。与PEP相关的关键手术预测指标为任何导丝进入PD(2.18,高)、首次有原生乳头的ERCP(1.91,高)、内镜下乳头球囊扩张完整乳头(2.91,中等)、胰腺腺泡化(4.23,低)、任何PD插管(2.73,低)、胰腺括约肌切开术(2.64,低)、插管困难(2.60,低)、任何胰腺造影(2.40,低)和预切括约肌切开术(1.98,低)。结论:我们的荟萃分析侧重于调整风险因素,以提供PEP最重要风险因素的精确估计。将我们的结果纳入预测模型可以可靠地帮助识别高危患者,优化知情同意,并指导PEP的预防和管理策略。
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来源期刊
CiteScore
16.90
自引率
4.80%
发文量
903
审稿时长
22 days
期刊介绍: Clinical Gastroenterology and Hepatology (CGH) is dedicated to offering readers a comprehensive exploration of themes in clinical gastroenterology and hepatology. Encompassing diagnostic, endoscopic, interventional, and therapeutic advances, the journal covers areas such as cancer, inflammatory diseases, functional gastrointestinal disorders, nutrition, absorption, and secretion. As a peer-reviewed publication, CGH features original articles and scholarly reviews, ensuring immediate relevance to the practice of gastroenterology and hepatology. Beyond peer-reviewed content, the journal includes invited key reviews and articles on endoscopy/practice-based technology, health-care policy, and practice management. Multimedia elements, including images, video abstracts, and podcasts, enhance the reader's experience. CGH remains actively engaged with its audience through updates and commentary shared via platforms such as Facebook and Twitter.
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