Incidence and risk factors for post-ERCP pancreatitis in pancreas divisum patients without chronic pancreatitis

Comparison of the incidence of post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with and without diabetes: a meta-analysis

BACKGROUND

Pancreatitis is a common complication for patients receiving endoscopic retrograde cholangiopancreatography (ERCP). The objective of the meta-analysis was to compare the incidence of post-ERCP pancreatitis (PEP) in individuals with and without pre-existing diabetes.

METHODS

A comprehensive review of the existing literature was carried out in PubMed, Embase, and Web of Science to identify applicable observational studies. The data were combined using a random-effects model while accounting for potential heterogeneity.

RESULTS

A total of 16 datasets from 14 observational studies involving 158,847 patients who received ERCP were included. Among them, 26,823 (16.9%) had pre-existing diabetes, and 24,654 (15.5%) had developed PEP. The pooled results showed that, compared to patients without diabetes, those with pre-existing diabetes had a lower incidence of PEP (odds ratio: 0.77, 95% confidence interval: 0.63 to 0.94, p = 0.01; I2 = 52%). A sensitivity analysis conducted by excluding one dataset at a time showed similar results (OR 0.74 to 0.81, p all < 0.05). Further subgroup and meta-regression analyses indicated that the link between diabetes and a decreased likelihood of PEP was not notably influenced by study factors such as country, average age, male representation, diabetes prevalence, incidence of PEP among the patients studied, diagnostic methods for PEP, or study quality scores.

CONCLUSIONS

Integrated evidence from observational studies currently indicate that diabetes could potentially act as a protective element against PEP. However, it is important to confirm these findings through extensive prospective studies that account for various influencing factors.

Incidence and Clinical Implications of Anatomical Variations in the Pancreas and Its Ductal System: A Systematic Review and Meta-Analysis

OBJECTIVE

This systematic review analyzes the anatomical variants in the pancreas and its ductal system to report on their association with pancreatic pathologies.

METHODS

We conducted a search of the MEDLINE, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS databases from their inception to July 2023. The methodological quality was assessed with the Anatomical Quality Assessment (AQUA) tool. Finally, the pooled prevalence was estimated using a random effects model.

RESULTS

55 studies were found that met the eligibility criteria. The overall prevalence of pancreas divisum (PD) was 18% (95% CI = 15-21%). The prevalence of PD associated with pancreatitis was 30% (95% CI = 1-61%).

CONCLUSIONS

An anatomical variant of the pancreas such as PD may be the cause of bile duct obstruction, resulting in various clinical complications, such as pancreatitis. Hence, knowing this variant is extremely important for surgeons, especially for those who treat the gastroduodenal region.

Endotherapy in Pancreatic Diseases

Interventional endoscopy is now considered an effective minimally invasive treatment modality for the management of pancreatic diseases. It is important for the clinician to know the indications and contraindications as well as the timing of various endoscopic interventions. This will help in its safe and effective use and consequently decrease morbidity and mortality from various pancreatic diseases. This review will provide a broad overview of the indications, techniques, and outcomes of pancreatic endotherapy.

Analysis of the Efficacy and Safety of Endoscopic Retrograde Cholangiopancreatography in Children With Symptomatic Pancreas Divisum

Background: Endoscopic retrograde cholangiopancreatography (ERCP) has been increasingly performed in children with symptomatic pancreas divisum (PD). Aim: To investigate the safety and efficacy of ERCP in the treatment of children with symptomatic PD. Methods: We performed a retrospective analysis on children with PD who were treated with ERCP at Shanghai Children's Medical Center between June 2015 and May 2020. Pertinent patient, clinical and procedural data were collected to assess the therapeutic effects and identify the risk factors for post-ERCP pancreatitis (PEP). Results: Overall, 114 ERCPs were performed in 46 children with PD. With a median follow-up of 28.5 months (12-71 months), 40 (87.0%) children achieved clinical remission, the median number of acute pancreatitis episodes decreased from four times per year pre-operatively to once per year post-operatively (P < 0.001), and the nutritional score improved post-operatively (P = 0.004). The incidence of PEP was 7.9%, and female sex, stone extraction, and gene mutations were identified as possible risk factors for PEP on univariate analysis. However, there was no statistical significance on multivariate analysis (P > 0.05). Conclusion: Therapeutic ERCP is an effective and safe intervention for children with symptomatic PD.