| Objective To evaluate the efficacy and safety of early endoscopic retrograde cholangiopancreatography(ERCP)± endoscopicsphincterotomy(EST)on patients with acute biliary pancreatitis(ABP).Methods Databases including Pub Med,The Cochrane library,EMBASE,CBM,CNKI,Wan Fang Data and VIP were searched resection up to September 2017.Randomized controlled trails(RCTs)conterning the comparison of ERCP±EST versus conservative management in ABP patients were enrolled in the study.Two reviewers independently assessed study quality and extracted data.All data were analysed using Rev Man5.3.Results A total of 10 RCTs involving 1752 cases were included in the meta-analysis.The results of meta-analysis showed that,compared with the control group,early ERCP±EST reduced the systemic complication rate of ABP(RR = 0.66;95%CI,0.47 to 0.93;P < 0.05),However,there were no significant differences in overall mortality,local complication rate,and ERCP related complication rate in ABP between early and selected ERCP±EST treat.Subgroup analyses indicated that early ERCP±EST therapy reduced the mortality of Severe acute biliary pancreatitis(SABP),ABP with biliary obstruction and within 24 hours of admission(RR = 0.48,0.35,0.25;95%CI,0.24 to 0.96,0.17 to 0.74,0.09 to 0.73;P < 0.05);decreased the local and systemic complication rate of SABP,ABP with biliary obstruction(RR = 0.56,0.54,0.51,0.51;95%CI,0.37 to 0.86,0.33 to0.91,0.32 to 0.81,0.32 to 0.80;P < 0.05);reduced the local and systemic complication rate of SABP(RR = 0.42,0.47;95%CI,0.25 to 0.70,0.25 to0.87;P < 0.05)and shortened the hospital stay of SABP(MD =-11.22 days;95%CI,-16.09 to-6.36;P < 0.01).However,there were no significant differences of overall complication rate in ABP without biliary obstruction and hospital stay in MABPConclusions Early ERCP±EST therapy appears to be safe and effective for ABP patients.Due to the limited quality and quantity of included studies,the above results are needed to verfy by more studies. |
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