Evidence map›Paper›PMID 39500841›Full record

SynthesisDigestive diseases and sciences2024

Preventive Measures and Risk Factors for Post-ERCP Pancreatitis: A Systematic Review and Individual Patient Data Meta-Analysis.

Christina J Sperna Weiland, Venkata S Akshintala, Anmol Singh, James Buxbaum, Jun-Ho Choi, Badih J Elmunzer, Evan S Fogel, Jian-Han Lai, John M Levenick, Timothy B Gardner and 9 more

Abstract readSystematic ReviewMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Digestive diseases and sciences, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
17citing papers in PubMed, 3 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

17 citing papers in PubMed, 3 syntheses or guidelines pooled it.

  1. Pooled it
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  14. Review
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  16. Why is the rectal route for NSAIDS favorable for preventing post-ERCP pancreatitis?Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] · 2025
    Article
  17. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

19 authors.

Christina J Sperna Weiland *Department of Gastroenterology and Hepatology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GM, Nijmegen, Netherlands. Christa.spernaweiland@radboudumc.nl.
Venkata S Akshintala *Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Anmol SinghDivision of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
James BuxbaumDivision of Gastroenterology, Keck School of Medicine, University of South California, Los Angeles, CA, USA.
Jun-Ho ChoiDepartment of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea.
Badih J ElmunzerDivision of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, SC, USA.
Evan S FogelDepartment of Medicine, Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA.
Jian-Han LaiDivision of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan.
John M LevenickSection of Gastroenterology and Hepatology, Penn State Hershey Medical Center, Hershey, PA, USA.
Timothy B GardnerDivision of Gastroenterology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
Guan W LuaDepartment of Gastroenterology, Raja Perempuan 2 Hospital, Kota Bharu, Kelantan, Malaysia.
Hui LuoHospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.
Mike de JongDepartment of Gastroenterology and Hepatology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GM, Nijmegen, Netherlands.
Shaffer R S MokGI Oncology, Moffitt Cancer Center, Tampa, FL, USA.
Veit PhillipDepartment of Internal Medicine II, School of Medicine, University Hospital Rechts der Isar, Technical University of Munich, Munich, Germany.
Vikesh SinghDivision of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Peter D SiersemaDepartment of Gastroenterology and Hepatology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GM, Nijmegen, Netherlands.
Joost P H DrenthDepartment of Gastroenterology and Hepatology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GM, Nijmegen, Netherlands.
Erwin J M van GeenenDepartment of Gastroenterology and Hepatology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GM, Nijmegen, Netherlands.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPost-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is the most common complication of ERCP, with limited studies comparing combined prophylactic measures and their efficacy relative to individual patient risk profiles. This study aims to perform an individual patient data meta-analysis (IPDMA) to evaluate the contribution of patient and ERCP-related risk factors to PEP development and to identify the best prophylaxis strategies according to the patient's risk profile.

methodsWe systematically searched MEDLINE, Embase, and Cochrane databases until November 2022 for randomized controlled PEP prophylaxis trials. We invited authors to share individual patient data, including PEP risk profile and prophylaxes used. PEP incidence rates for different prophylaxis were calculated. Efficacy was compared using multilevel logistic regression and expressed as relative risk (RR). Subgroup analysis evaluated the role of patient and ERCP-related risk factors in developing PEP.

resultsData from 11 studies, including 6430 patients, were analyzed. After adjusting for risk factors, rectal NSAIDs (RR 0.69, 95%CI 0.54-0.88) and peri-procedural high-volume intravenous fluid (IVF) (RR 0.40, 95%CI 0.21-0.79) were effective in reducing PEP incidence, while no benefit was noted with pancreatic duct (PD) stents (RR 1.25, 95%CI 0.91-1.73). In patients receiving rectal NSAIDs (n = 2617), difficult cannulation (RR 1.99, 1.45-2.73), contrast injection into the pancreatic duct (PD) (RR2.37, 1.68-3.32), and prior history of PEP (RR 1.90, 1.06-3.41) were associated with increased PEP risk.

conclusionThis IPDMA confirms that rectal NSAIDs and peri-procedural IVF are effective PEP prophylactic strategies. Further studies focusing on combination therapy or the development of personalized PEP risk calculators are needed to improve prophylactic strategies.

Indexed as

Cholangiopancreatography, Endoscopic RetrogradePancreatitisAnti-Inflammatory Agents, Non-SteroidalHumansRisk FactorsAnti-Inflammatory Agents, Non-SteroidalERCPPancreatitisPatient-level meta-analysisPEPRectal indomethacin

Identifiers

PMID39500841
PMCPMC11602798

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.