Early intervention leads to better outcomes in severe acute biliary pancreatitis

Early endoscopic intervention offers better outcomes in severe acute biliary pancreatitis (SABP) as compared with conservative treatments, a recent meta-analysis has shown.

The authors included nine randomized controlled trials, yielding a cumulative sample of 879 SABP patients. Those who received early endoscopic intervention saw a 40-percent drop in their odds of death, as compared to conservative treatment (odds ratio [OR], 0.60, 95 percent confidence interval [CI], 0.38–0.98; p=0.04).

Similarly, the likelihood of cholangitis was strongly suppressed in patients treated with early endoscopy (OR, 0.11, 95 percent CI, 0.03–0.42; p=0.001).

Early intervention also lowered the risk of complications overall (OR, 0.57, 95 percent CI, 0.34–0.94; p=0.034), as well as those occurring systemically (OR, 0.34, 95 percent CI, 0.19–0.59; p=0.0001) and locally (OR, 0.37, 95 percent CI, 0.19–0.73; p=0.004).

In contrast, early endoscopy showed no particular advantage over conservative treatments in terms of bacteraemia, respiratory complications, and multiple organ dysfunction. Subgroup analysis also showed that early intervention tended to be more beneficial to SABP patients with cholestasis.

Important limitations of the current study included its relatively small sample size, the inclusion of only articles published in English, and potential inter-study differences in the quantification of disease severity and the implementation of conservative treatment.

“[C]onsidering some limitations of our study, more high-quality, large sample, and multicenter RCTs are required to verify the reliability of our conclusions,” the researchers said.