Comparative Risks of Post-ERCP Adverse Events in Patients with Asymptomatic and Symptomatic Choledocholithiasis: A Systematic Review and Meta-Analysis
Background and Aims Endoscopic retrograde cholangiopancreatography (ERCP) is the standard of care for the management of choledocholithiasis but carries risk of complications which may result in significant morbidity and mortality. While currently available guidelines endorse the use of ERCP for the...
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| Veröffentlicht in: | Digestive diseases and sciences 2024-05, Vol.69 (5), p.1880-1888 |
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| creator | Obaitan, Itegbemie Mohamed, Mouhand F. H. Beran, Azizullah Rosenheck, Michael Obomanu, Elvis T. Berzin, Tyler M. Ramai, Daryl Wehbe, Hisham Aziz, Muhammad Mahendraker, Neetu Al-Haddad, Mohammad Easler, Jeffrey J. Fogel, Evan L. |
| description | Background and Aims
Endoscopic retrograde cholangiopancreatography (ERCP) is the standard of care for the management of choledocholithiasis but carries risk of complications which may result in significant morbidity and mortality. While currently available guidelines endorse the use of ERCP for the management of symptomatic common bile duct stones, the need for ERCP in incidentally found asymptomatic choledocholithiasis is more controversial, and practice varies on a geographic and institutional level. This systematic review and meta-analysis is conducted to compare post-ERCP adverse events between asymptomatic and symptomatic choledocholithiasis patients.
Methods
We searched PubMed/Embase/Web of Science databases to include all studies comparing post-ERCP outcomes between asymptomatic and symptomatic choledocholithiasis patients. The primary outcome was post-ERCP pancreatitis (PEP), while secondary outcomes included post-ERCP cholangitis, bleeding, and perforation. We calculated pooled risk ratios (RR) and 95% confidence intervals (CIs) using the Mantel–Haenszel method within a random-effect model.
Results
Our analysis included six observational studies, totaling 2,178 choledocholithiasis patients (392 asymptomatic and 1786 symptomatic); 53% were female. Asymptomatic patients exhibited a higher risk of PEP compared with symptomatic patients (11.7% versus 4.8%; RR 2.59, 95% CI 1.56–4.31,
p
≤ 0.001). No significant difference was observed in post-ERCP cholangitis, bleeding, or perforation rates between the two groups.
Conclusions
Asymptomatic patients with choledocholithiasis appear to have a higher risk of PEP than symptomatic patients, while the risk of other post-ERCP adverse events is similar between the two groups. Interventional endoscopists should thoroughly discuss potential adverse events (particularly PEP) with asymptomatic patients before performing ERCP and utilize PEP-prevention measures more liberally in this subgroup of patients. |
| doi_str_mv | 10.1007/s10620-024-08374-0 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_3022571530</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3022571530</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-ff73cf770d77819e5bdc937e906f30b994d251c309bc601cb2d262baf4c76f323</originalsourceid><addsrcrecordid>eNp9kc9u1DAQhy0EokvhBTggS1y4BMb22k64RdHyR2rFaoGz5TgOTUniJePdal-E58W7KQX10ItnbH_zs6WPkJcM3jIA_Q4ZKA4Z8GUGudBpfUQWTGqRcanyx2QBTKWeMXVGniFeA0ChmXpKzkQupRS8WJDfVRi2drKx23u66fAn0tDSdcCYrTbVmpbN3k_o6Wrvx4i0G-k6saf-potXtMTDsI1hSIeO2rGhX__bV1eh901wqSS2s9jhe1omBKOfiY3fd_7mNHjpo83K0faHhD0nT1rbo39xW8_J9w-rb9Wn7OLLx89VeZE5oWXM2lYL12oNjdY5K7ysG1cI7QtQrYC6KJYNl8wJKGqngLmaN1zx2rZLpxPBxTl5M-dup_Br5zGaoUPn-96OPuzQCOBcaiYFJPT1PfQ67Kb03yMlpZJM5SJRfKbcFBAn35rt1A12OhgG5mjNzNZMsmZO1swx-tVt9K4efHM38ldTAsQMYLoaf_jp39sPxP4BAoejwg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3055651683</pqid></control><display><type>article</type><title>Comparative Risks of Post-ERCP Adverse Events in Patients with Asymptomatic and Symptomatic Choledocholithiasis: A Systematic Review and Meta-Analysis</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Obaitan, Itegbemie ; Mohamed, Mouhand F. H. ; Beran, Azizullah ; Rosenheck, Michael ; Obomanu, Elvis T. ; Berzin, Tyler M. ; Ramai, Daryl ; Wehbe, Hisham ; Aziz, Muhammad ; Mahendraker, Neetu ; Al-Haddad, Mohammad ; Easler, Jeffrey J. ; Fogel, Evan L.</creator><creatorcontrib>Obaitan, Itegbemie ; Mohamed, Mouhand F. H. ; Beran, Azizullah ; Rosenheck, Michael ; Obomanu, Elvis T. ; Berzin, Tyler M. ; Ramai, Daryl ; Wehbe, Hisham ; Aziz, Muhammad ; Mahendraker, Neetu ; Al-Haddad, Mohammad ; Easler, Jeffrey J. ; Fogel, Evan L.</creatorcontrib><description>Background and Aims
Endoscopic retrograde cholangiopancreatography (ERCP) is the standard of care for the management of choledocholithiasis but carries risk of complications which may result in significant morbidity and mortality. While currently available guidelines endorse the use of ERCP for the management of symptomatic common bile duct stones, the need for ERCP in incidentally found asymptomatic choledocholithiasis is more controversial, and practice varies on a geographic and institutional level. This systematic review and meta-analysis is conducted to compare post-ERCP adverse events between asymptomatic and symptomatic choledocholithiasis patients.
Methods
We searched PubMed/Embase/Web of Science databases to include all studies comparing post-ERCP outcomes between asymptomatic and symptomatic choledocholithiasis patients. The primary outcome was post-ERCP pancreatitis (PEP), while secondary outcomes included post-ERCP cholangitis, bleeding, and perforation. We calculated pooled risk ratios (RR) and 95% confidence intervals (CIs) using the Mantel–Haenszel method within a random-effect model.
Results
Our analysis included six observational studies, totaling 2,178 choledocholithiasis patients (392 asymptomatic and 1786 symptomatic); 53% were female. Asymptomatic patients exhibited a higher risk of PEP compared with symptomatic patients (11.7% versus 4.8%; RR 2.59, 95% CI 1.56–4.31,
p
≤ 0.001). No significant difference was observed in post-ERCP cholangitis, bleeding, or perforation rates between the two groups.
Conclusions
Asymptomatic patients with choledocholithiasis appear to have a higher risk of PEP than symptomatic patients, while the risk of other post-ERCP adverse events is similar between the two groups. Interventional endoscopists should thoroughly discuss potential adverse events (particularly PEP) with asymptomatic patients before performing ERCP and utilize PEP-prevention measures more liberally in this subgroup of patients.</description><identifier>ISSN: 0163-2116</identifier><identifier>ISSN: 1573-2568</identifier><identifier>EISSN: 1573-2568</identifier><identifier>DOI: 10.1007/s10620-024-08374-0</identifier><identifier>PMID: 38555329</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Asymptomatic ; Asymptomatic Diseases ; Biochemistry ; Cholangiopancreatography, Endoscopic Retrograde - adverse effects ; Cholangitis ; Cholangitis - epidemiology ; Cholangitis - etiology ; Choledocholithiasis - surgery ; Gastroenterology ; Hepatology ; Humans ; Medicine ; Medicine & Public Health ; Oncology ; Original Article ; Pancreatitis - epidemiology ; Pancreatitis - etiology ; Postoperative Complications - diagnosis ; Postoperative Complications - epidemiology ; Postoperative Complications - etiology ; Risk Factors ; Systematic review ; Transplant Surgery</subject><ispartof>Digestive diseases and sciences, 2024-05, Vol.69 (5), p.1880-1888</ispartof><rights>The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-ff73cf770d77819e5bdc937e906f30b994d251c309bc601cb2d262baf4c76f323</citedby><cites>FETCH-LOGICAL-c375t-ff73cf770d77819e5bdc937e906f30b994d251c309bc601cb2d262baf4c76f323</cites><orcidid>0000-0001-5002-6821</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10620-024-08374-0$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10620-024-08374-0$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38555329$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Obaitan, Itegbemie</creatorcontrib><creatorcontrib>Mohamed, Mouhand F. H.</creatorcontrib><creatorcontrib>Beran, Azizullah</creatorcontrib><creatorcontrib>Rosenheck, Michael</creatorcontrib><creatorcontrib>Obomanu, Elvis T.</creatorcontrib><creatorcontrib>Berzin, Tyler M.</creatorcontrib><creatorcontrib>Ramai, Daryl</creatorcontrib><creatorcontrib>Wehbe, Hisham</creatorcontrib><creatorcontrib>Aziz, Muhammad</creatorcontrib><creatorcontrib>Mahendraker, Neetu</creatorcontrib><creatorcontrib>Al-Haddad, Mohammad</creatorcontrib><creatorcontrib>Easler, Jeffrey J.</creatorcontrib><creatorcontrib>Fogel, Evan L.</creatorcontrib><title>Comparative Risks of Post-ERCP Adverse Events in Patients with Asymptomatic and Symptomatic Choledocholithiasis: A Systematic Review and Meta-Analysis</title><title>Digestive diseases and sciences</title><addtitle>Dig Dis Sci</addtitle><addtitle>Dig Dis Sci</addtitle><description>Background and Aims
Endoscopic retrograde cholangiopancreatography (ERCP) is the standard of care for the management of choledocholithiasis but carries risk of complications which may result in significant morbidity and mortality. While currently available guidelines endorse the use of ERCP for the management of symptomatic common bile duct stones, the need for ERCP in incidentally found asymptomatic choledocholithiasis is more controversial, and practice varies on a geographic and institutional level. This systematic review and meta-analysis is conducted to compare post-ERCP adverse events between asymptomatic and symptomatic choledocholithiasis patients.
Methods
We searched PubMed/Embase/Web of Science databases to include all studies comparing post-ERCP outcomes between asymptomatic and symptomatic choledocholithiasis patients. The primary outcome was post-ERCP pancreatitis (PEP), while secondary outcomes included post-ERCP cholangitis, bleeding, and perforation. We calculated pooled risk ratios (RR) and 95% confidence intervals (CIs) using the Mantel–Haenszel method within a random-effect model.
Results
Our analysis included six observational studies, totaling 2,178 choledocholithiasis patients (392 asymptomatic and 1786 symptomatic); 53% were female. Asymptomatic patients exhibited a higher risk of PEP compared with symptomatic patients (11.7% versus 4.8%; RR 2.59, 95% CI 1.56–4.31,
p
≤ 0.001). No significant difference was observed in post-ERCP cholangitis, bleeding, or perforation rates between the two groups.
Conclusions
Asymptomatic patients with choledocholithiasis appear to have a higher risk of PEP than symptomatic patients, while the risk of other post-ERCP adverse events is similar between the two groups. Interventional endoscopists should thoroughly discuss potential adverse events (particularly PEP) with asymptomatic patients before performing ERCP and utilize PEP-prevention measures more liberally in this subgroup of patients.</description><subject>Asymptomatic</subject><subject>Asymptomatic Diseases</subject><subject>Biochemistry</subject><subject>Cholangiopancreatography, Endoscopic Retrograde - adverse effects</subject><subject>Cholangitis</subject><subject>Cholangitis - epidemiology</subject><subject>Cholangitis - etiology</subject><subject>Choledocholithiasis - surgery</subject><subject>Gastroenterology</subject><subject>Hepatology</subject><subject>Humans</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Oncology</subject><subject>Original Article</subject><subject>Pancreatitis - epidemiology</subject><subject>Pancreatitis - etiology</subject><subject>Postoperative Complications - diagnosis</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - etiology</subject><subject>Risk Factors</subject><subject>Systematic review</subject><subject>Transplant Surgery</subject><issn>0163-2116</issn><issn>1573-2568</issn><issn>1573-2568</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc9u1DAQhy0EokvhBTggS1y4BMb22k64RdHyR2rFaoGz5TgOTUniJePdal-E58W7KQX10ItnbH_zs6WPkJcM3jIA_Q4ZKA4Z8GUGudBpfUQWTGqRcanyx2QBTKWeMXVGniFeA0ChmXpKzkQupRS8WJDfVRi2drKx23u66fAn0tDSdcCYrTbVmpbN3k_o6Wrvx4i0G-k6saf-potXtMTDsI1hSIeO2rGhX__bV1eh901wqSS2s9jhe1omBKOfiY3fd_7mNHjpo83K0faHhD0nT1rbo39xW8_J9w-rb9Wn7OLLx89VeZE5oWXM2lYL12oNjdY5K7ysG1cI7QtQrYC6KJYNl8wJKGqngLmaN1zx2rZLpxPBxTl5M-dup_Br5zGaoUPn-96OPuzQCOBcaiYFJPT1PfQ67Kb03yMlpZJM5SJRfKbcFBAn35rt1A12OhgG5mjNzNZMsmZO1swx-tVt9K4efHM38ldTAsQMYLoaf_jp39sPxP4BAoejwg</recordid><startdate>20240501</startdate><enddate>20240501</enddate><creator>Obaitan, Itegbemie</creator><creator>Mohamed, Mouhand F. H.</creator><creator>Beran, Azizullah</creator><creator>Rosenheck, Michael</creator><creator>Obomanu, Elvis T.</creator><creator>Berzin, Tyler M.</creator><creator>Ramai, Daryl</creator><creator>Wehbe, Hisham</creator><creator>Aziz, Muhammad</creator><creator>Mahendraker, Neetu</creator><creator>Al-Haddad, Mohammad</creator><creator>Easler, Jeffrey J.</creator><creator>Fogel, Evan L.</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-5002-6821</orcidid></search><sort><creationdate>20240501</creationdate><title>Comparative Risks of Post-ERCP Adverse Events in Patients with Asymptomatic and Symptomatic Choledocholithiasis: A Systematic Review and Meta-Analysis</title><author>Obaitan, Itegbemie ; Mohamed, Mouhand F. H. ; Beran, Azizullah ; Rosenheck, Michael ; Obomanu, Elvis T. ; Berzin, Tyler M. ; Ramai, Daryl ; Wehbe, Hisham ; Aziz, Muhammad ; Mahendraker, Neetu ; Al-Haddad, Mohammad ; Easler, Jeffrey J. ; Fogel, Evan L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-ff73cf770d77819e5bdc937e906f30b994d251c309bc601cb2d262baf4c76f323</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Asymptomatic</topic><topic>Asymptomatic Diseases</topic><topic>Biochemistry</topic><topic>Cholangiopancreatography, Endoscopic Retrograde - adverse effects</topic><topic>Cholangitis</topic><topic>Cholangitis - epidemiology</topic><topic>Cholangitis - etiology</topic><topic>Choledocholithiasis - surgery</topic><topic>Gastroenterology</topic><topic>Hepatology</topic><topic>Humans</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Oncology</topic><topic>Original Article</topic><topic>Pancreatitis - epidemiology</topic><topic>Pancreatitis - etiology</topic><topic>Postoperative Complications - diagnosis</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative Complications - etiology</topic><topic>Risk Factors</topic><topic>Systematic review</topic><topic>Transplant Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Obaitan, Itegbemie</creatorcontrib><creatorcontrib>Mohamed, Mouhand F. H.</creatorcontrib><creatorcontrib>Beran, Azizullah</creatorcontrib><creatorcontrib>Rosenheck, Michael</creatorcontrib><creatorcontrib>Obomanu, Elvis T.</creatorcontrib><creatorcontrib>Berzin, Tyler M.</creatorcontrib><creatorcontrib>Ramai, Daryl</creatorcontrib><creatorcontrib>Wehbe, Hisham</creatorcontrib><creatorcontrib>Aziz, Muhammad</creatorcontrib><creatorcontrib>Mahendraker, Neetu</creatorcontrib><creatorcontrib>Al-Haddad, Mohammad</creatorcontrib><creatorcontrib>Easler, Jeffrey J.</creatorcontrib><creatorcontrib>Fogel, Evan L.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Digestive diseases and sciences</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Obaitan, Itegbemie</au><au>Mohamed, Mouhand F. H.</au><au>Beran, Azizullah</au><au>Rosenheck, Michael</au><au>Obomanu, Elvis T.</au><au>Berzin, Tyler M.</au><au>Ramai, Daryl</au><au>Wehbe, Hisham</au><au>Aziz, Muhammad</au><au>Mahendraker, Neetu</au><au>Al-Haddad, Mohammad</au><au>Easler, Jeffrey J.</au><au>Fogel, Evan L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparative Risks of Post-ERCP Adverse Events in Patients with Asymptomatic and Symptomatic Choledocholithiasis: A Systematic Review and Meta-Analysis</atitle><jtitle>Digestive diseases and sciences</jtitle><stitle>Dig Dis Sci</stitle><addtitle>Dig Dis Sci</addtitle><date>2024-05-01</date><risdate>2024</risdate><volume>69</volume><issue>5</issue><spage>1880</spage><epage>1888</epage><pages>1880-1888</pages><issn>0163-2116</issn><issn>1573-2568</issn><eissn>1573-2568</eissn><abstract>Background and Aims
Endoscopic retrograde cholangiopancreatography (ERCP) is the standard of care for the management of choledocholithiasis but carries risk of complications which may result in significant morbidity and mortality. While currently available guidelines endorse the use of ERCP for the management of symptomatic common bile duct stones, the need for ERCP in incidentally found asymptomatic choledocholithiasis is more controversial, and practice varies on a geographic and institutional level. This systematic review and meta-analysis is conducted to compare post-ERCP adverse events between asymptomatic and symptomatic choledocholithiasis patients.
Methods
We searched PubMed/Embase/Web of Science databases to include all studies comparing post-ERCP outcomes between asymptomatic and symptomatic choledocholithiasis patients. The primary outcome was post-ERCP pancreatitis (PEP), while secondary outcomes included post-ERCP cholangitis, bleeding, and perforation. We calculated pooled risk ratios (RR) and 95% confidence intervals (CIs) using the Mantel–Haenszel method within a random-effect model.
Results
Our analysis included six observational studies, totaling 2,178 choledocholithiasis patients (392 asymptomatic and 1786 symptomatic); 53% were female. Asymptomatic patients exhibited a higher risk of PEP compared with symptomatic patients (11.7% versus 4.8%; RR 2.59, 95% CI 1.56–4.31,
p
≤ 0.001). No significant difference was observed in post-ERCP cholangitis, bleeding, or perforation rates between the two groups.
Conclusions
Asymptomatic patients with choledocholithiasis appear to have a higher risk of PEP than symptomatic patients, while the risk of other post-ERCP adverse events is similar between the two groups. Interventional endoscopists should thoroughly discuss potential adverse events (particularly PEP) with asymptomatic patients before performing ERCP and utilize PEP-prevention measures more liberally in this subgroup of patients.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>38555329</pmid><doi>10.1007/s10620-024-08374-0</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0001-5002-6821</orcidid></addata></record> |
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| identifier | ISSN: 0163-2116 |
| ispartof | Digestive diseases and sciences, 2024-05, Vol.69 (5), p.1880-1888 |
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| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Asymptomatic Asymptomatic Diseases Biochemistry Cholangiopancreatography, Endoscopic Retrograde - adverse effects Cholangitis Cholangitis - epidemiology Cholangitis - etiology Choledocholithiasis - surgery Gastroenterology Hepatology Humans Medicine Medicine & Public Health Oncology Original Article Pancreatitis - epidemiology Pancreatitis - etiology Postoperative Complications - diagnosis Postoperative Complications - epidemiology Postoperative Complications - etiology Risk Factors Systematic review Transplant Surgery |
| title | Comparative Risks of Post-ERCP Adverse Events in Patients with Asymptomatic and Symptomatic Choledocholithiasis: A Systematic Review and Meta-Analysis |
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