Urgent endoscopic retrograde cholangiopancreatography with sphincterotomy versus conservative treatment in predicted severe acute gallstone pancreatitis (APEC): a multicentre randomised controlled trial

Lancet
Nicolien J SchepersDutch Pancreatitis Study Group

Abstract

It remains unclear whether urgent endoscopic retrograde cholangiopancreatography (ERCP) with biliary sphincterotomy improves the outcome of patients with gallstone pancreatitis without concomitant cholangitis. We did a randomised trial to compare urgent ERCP with sphincterotomy versus conservative treatment in patients with predicted severe acute gallstone pancreatitis. In this multicentre, parallel-group, assessor-masked, randomised controlled superiority trial, patients with predicted severe (Acute Physiology and Chronic Health Evaluation II score ≥8, Imrie score ≥3, or C-reactive protein concentration >150 mg/L) gallstone pancreatitis without cholangitis were assessed for eligibility in 26 hospitals in the Netherlands. Patients were randomly assigned (1:1) by a web-based randomisation module with randomly varying block sizes to urgent ERCP with sphincterotomy (within 24 h after hospital presentation) or conservative treatment. The primary endpoint was a composite of mortality or major complications (new-onset persistent organ failure, cholangitis, bacteraemia, pneumonia, pancreatic necrosis, or pancreatic insufficiency) within 6 months of randomisation. Analysis was by intention to treat. This trial is registered with the IS...Continue Reading

Citations

Sep 11, 2020·Langenbeck's Archives of Surgery·Max HecklerJohn P Neoptolemos
Dec 15, 2020·Pancreatology : Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]·Dániel PécsiUNKNOWN Hungarian Endoscopy Study Group
Nov 25, 2020·Current Treatment Options in Gastroenterology·Peter J Lee, Georgios I Papachristou
Jan 20, 2021·Current Opinion in Critical Care·Pieter SinonquelAlexander Wilmer
Mar 8, 2021·La Revue de médecine interne·A GuyotT Degand
Sep 22, 2021·Der Internist·Marcus HollenbachAlbrecht Hoffmeister
Sep 7, 2020·Lancet·Lotte BoxhoornMarc G Besselink
Nov 17, 2021·Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen·Stephan SchornHelmut Friess

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