Background & Aims

Endoscopic retrograde cholangiopancreatography (ERCP)-related adverse events (AEs) are associated with morbidity, mortality, and healthcare expenditure. We aimed to assess incidences and comparisons of ERCP AEs.

Methods

We included studies performed after 2000 reporting on ERCP AEs from database inception through March 12, 2024. Outcomes included pancreatitis, bleeding, cholangitis, cholecystitis, perforation, and death. DerSimonian and Laird random effects meta-analyses were performed to calculate incidences of AEs. Subgroup and pairwise meta-analyses were performed. Meta-regression was performed on median recruitment year to assess temporal trends in pancreatitis incidence.

Results

A total of 380 studies were included. The incidence of death attributable to ERCP was 0.2% (95% confidence intervals, CI, 0.1-0.3%, I² 44%, n=47,258) in all-comers. The overall incidence of pancreatitis was 4.6% (95% CI 4.0-5.1%, I² 96%, n=293,378) among all-comers and 6.5% (95% CI 5.9-7.1%, I² 89%, n=88,809) among first-time patients. Pancreatitis incidence remained stable between 2000-2023 (average annual percent change 0.06, 95%CI -0.27 to 0.39). The overall incidences of the following AEs for all-comers were: bleeding (1.5%, 95% CI 1.2-1.7%, I² 93%, n=229,655), cholangitis (2.5%, 95%CI 1.9-3.3%, I² 96%, n=121,619), cholecystitis (0.8%, 95%CI 0.5-1.2%, I² 39%, n=7,799), and perforation (0.5%, 95%CI 0.4-0.6%, I² 90%, n=306,378).

Conclusions

ERCP-associated AEs remain common. Incidence of post-ERCP pancreatitis remained static despite improvements in techniques, prevention, and recognition. These results are important to patients, endoscopists, and policy makers to inform consent and to encourage implementation of available risk mitigation strategies.

中文翻译：

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与内窥镜逆行胰胆管造影相关的不良事件：系统评价和荟萃分析

 背景和目标

内窥镜逆行胰胆管造影 （ERCP） 相关不良事件 （AE） 与发病率、死亡率和医疗保健支出相关。我们旨在评估 ERCP AEs 的发生率和比较。

 方法

我们纳入了 2000 年之后进行的研究，这些研究报告了从数据库建立到 2024 年 3 月 12 日的 ERCP AEs。结局包括胰腺炎、出血、胆管炎、胆囊炎、穿孔和死亡。进行 DerSimonian 和 Laird 随机效应荟萃分析以计算 AE 的发生率。进行亚组和成对荟萃分析。在中位招募年进行 Meta 回归，以评估胰腺炎发病率的时间趋势。

 结果

共纳入 380 项研究。在所有参与者中，ERCP 归因于死亡的发生率为 0.2% （95% 置信区间，CI，0.1-0.3%，I² 44%，n=47,258）。胰腺炎的总发病率在全部患者中为 4.6% （95% CI 4.0-5.1%，I² 96%，n=293,378），在首次患者中为 6.5% （95% CI 5.9-7.1%，I² 89%，n=88,809）。胰腺炎发病率在 2000-2023 年期间保持稳定 （平均年百分比变化 0.06,95% CI -0.27 至 0.39）。所有参与者的以下 AE 的总发生率为：出血 （1.5%，95% CI 1.2-1.7%，I² 93%，n=229,655）、胆管炎 （2.5%，95% CI 1.9-3.3%，I² 96%，n=121,619）、胆囊炎 （0.8%，95% CI 0.5-1.2%，I² 39%，n=7,799）和穿孔 （0.5%，95%CI 0.4-0.6%，I² 90%，n=306,378）。

 结论

ERCP 相关的 AE 仍然很常见。尽管技术、预防和识别有所改进，但 ERCP 后胰腺炎的发病率保持不变。这些结果对患者、内窥镜医师和政策制定者很重要，可以告知同意并鼓励实施可用的风险缓解策略。