Ph.D (Research scholor) NIPER-GUWAHATI Guwahati, India
Background: Endoscopic retrograde cholangiopancreatography (ERCP) is a commonly used procedure for diagnosing and treating conditions of the biliary tract and pancreas. However, this procedure can also result in post-ERCP pancreatitis, a severe and potentially life-threatening complication.
Objectives: To evaluate the impact of the timing and procedures of cholecystectomy relative to ERCP on the risk of developing post-ERCP pancreatitis.
Methods: A thorough literature search was performed in PubMed, Cochrane CENTRAL, and Google Scholar from the inception of 10th January 2023. A combination of keywords, MeSH terms, and entry terms on Cholecystectomy, Laparoscopic Cholecystectomy, Pancreatitis, and Gallbladder disease was used in combination with Boolean operators. All randomized controlled trials (RCTs) examined mainly the influence of timing and procedures of cholecystectomy on the incidence of post-ERCP pancreatitis were included. The Random-effects model was used based on the heterogeneity identified using the I² statistic and Cochran's Q test.
Results: The results showed that the incidence of post-ERCP pancreatitis varied widely depending on the type of ERCP procedure performed. Out of 16 non-duplicate research articles identified through database searching, a total of 4 studies, with 3621 patients were included in this study. The risk of pancreatitis (OR 0.43, 95% CI: 0.26-0.72, p=0.001) was significantly lesser in the pre-ERCP procedure group than in the post-ERCP procedure group.
Conclusions: This systematic review & meta-analysis provides evidence that pre-ERCP cholecystectomy is associated with a lesser risk of post-ERCP pancreatitis than post-ERCP cholecystectomy. These findings have important implications for clinical practice and may guide decisions regarding the timing and procedure of cholecystectomy in patients undergoing ERCP. Further studies are needed to confirm these results and to identify the underlying mechanisms that contribute to this relationship.
