Meta-Analysis
Copyright ©The Author(s) 2018.
World J Gastrointest Endosc. Nov 16, 2018; 10(11): 354-366
Published online Nov 16, 2018. doi: 10.4253/wjge.v10.i11.354
Table 1 Description of 15 studies used in the final analysis
Ref.Yr of publicationCountryStudy typeCohort/ Case-controlYrNo. of patients
Navaneethan et al[5]2017United StatesRetrospectiveCase-control20103228
Jagtap et al[20]2017IndiaRetrospectiveCohort2014-2016134
Adler et al[16]2016United StatesRetrospectiveCohort2003-2014328
Inamdar et al[13]2016United StatesRetrospectiveCase-control20091930
Gill et al[14]2016PakistanRetrospectiveCase-control2008-2014100
Churrango et al[24]2016United StatesRetrospectiveCohort2008-2015194
Leal et al[19]2015SpainRetrospectiveCase-control2002-2014158
Zhang et al[2]2015ChinaRetrospectiveCohort2000-201477
Li et al[17]2014ChinaRetrospectiveCohort2000-200846
Ma et al[22]2013ChinaRetrospectiveCohort2002-201341
Artifon et al[21]2011BrazilProspectiveCase-controlNot specified105
Park et al[18]2004South KoreaProspective/RetrospectiveCase-control1998-200341
Prat et al[25]1996FranceRetrospectiveCohort1988-199352
Freeman et al[23]1995United StatesProspectiveCase-controlNot specified64
Sugiyama et al[15]1993JapanProspectiveCohortNot specified7
Table 2 Description of studies used for comparison meta-analysis
Ref.Yr publishedCountryStudy periodStudy type
Navaneethan et al[5]2017United States2010Retrospective (NIS), Multicenter
Inamdar et al[13]2016United States2009Retrospective (NIS), Multicenter
Gill et al[14]2016Pakistan2008-2014Retrospective, Single center
Leal et al[19]2015Spain2002-2014Retrospective, Single center
Li et al[17]2014China2000-2008Retrospective, Single center
Freeman et al[23]1995United StatesNSRetrospective, Multicenter
Table 3 Endoscopic retrograde cholangiopancreatography-related adverse events in cirrhosis patients
Ref.Total no. of patients (cirrhotics)Number of ERCPsPEPHemorrhageCholangitisPerforation% of complications
Navaneethan et al[5]32283228387168110614.5
Jagtap et al[20]134134214110011.9
Adler et al[16]3285382516115214.6
Inamdar et al[13]19301930160144115N/A11.3
Gill et al[14]10010031613012
Churrango et al[24]1941943151N/A04.1
Leal et al[19]158158719110117
Zhang et al[2]7777422421037.6
Li et al[17]464643233019.5
Ma et al[22]41410424004.8
Artifon et al[21]10510535750514.2
Park et al[18]414136664031.7
Prat et al[25]525201313113.4
Freeman et al[23]6464N/A151N/AN/A7.8
Sugiyama et al[15]H/B70*0*000
1PEP and bleeding definitions not clear. Most authors used standard accepted criteria for both;
2PEP: typical pancreatic pain without perforation and the level of amylase increased to ≥ 3 ULN after the procedure. Bleeding: hematemesis and/or melena, level of postoperative hemoglobin decreased by > 2 g/dL, or requirement of transfusion therapy;
3PEP: (1) new or worsened abdominal pain; (2) new or prolongation of hospitalization for at least 2 d; and (3) serum amylase ≥ 3 ULN, measured more than 24 h after the procedure. Bleeding: melena and/or hematemesis;
4PEP: Symptoms + Amylase > 500. Bleeding same as 2;
5PEP: (1) New or worse typical pain (epigastric radiating to the back) associated with tenderness to palpation; (2) Elevation of serum amylase or lipase ≥ 3 ULN; (3) Both (1) and (2) persist for 24 h after the ERCP. Bleeding: Not adequately defined;
6PEP: Amylase ≥ 3 ULN the morning after procedure + Symptoms. Bleeding: presence of clinical (not just endoscopic) evidence of bleeding, such as melena or hematemesis, with an associated decrease of at least 2 g/dL in the Hb concentration, or the need for a blood transfusion. ERCP: Endoscopic retrograde cholangiopancreatography; PEP: Post-ERCP pancreatitis; N/A: Not available.
Table 4 Methodological quality of included studies using the Newcastle-Ottawa scale
Ref.CountryStudy typeCohort/ Case-controlYrNo. of patientsNewcastle-Ottawa Scale
Outcome
SelectionComparability
Navaneethan et al[5]United StatesRetrospectiveCase-control20103228AC***
Jagtap et al[20]IndiaRetrospectiveCohort2014-2016134A**
Adler et al[16]United StatesRetrospectiveCohort2003-2014328AC***
Inamdar et al[13]United StatesRetrospectiveCase-control20091930AB**
Gill et al[14]PakistanRetrospectiveCase-control2008-2014100AC**
Churrango et al[24]United StatesRetrospectiveCohort2008-2015194AC**
Leal et al[19]SpainRetrospectiveCase-control2002-2014158AC***
Zhang et al[2]ChinaRetrospectiveCohort2000-201477AC***
Li et al[17]ChinaRetrospectiveCohort2000-200846AC***
Ma et al[22]ChinaRetrospectiveCohort2002-201341BC**
Artifon et al[21]BrazilProspectiveCase-controlNot specified105BC***
Park et al[18]South KoreaProspective/RetrospectiveCase-control1998-200341AC***
Prat et al[25]FranceRetrospectiveCohort1988-199352A+C***
Freeman et al[23]United StatesProspectiveCase-controlNot specified64AC***
Sugiyama et al[15]JapanProspectiveCohortNot specified7BC***
A+: Excellent; A: Very good; B: Good; C: Fair.