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Comparative Risks of Post-ERCP Adverse Events in Patients with Asymptomatic and Symptomatic Choledocholithiasis: A Systematic Review and Meta-Analysis

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Abstract

Background and Aims

Endoscopic retrograde cholangiopancreatography (ERCP) is the standard of care for the management of choledocholithiasis but carries risk of complications which may result in significant morbidity and mortality. While currently available guidelines endorse the use of ERCP for the management of symptomatic common bile duct stones, the need for ERCP in incidentally found asymptomatic choledocholithiasis is more controversial, and practice varies on a geographic and institutional level. This systematic review and meta-analysis is conducted to compare post-ERCP adverse events between asymptomatic and symptomatic choledocholithiasis patients.

Methods

We searched PubMed/Embase/Web of Science databases to include all studies comparing post-ERCP outcomes between asymptomatic and symptomatic choledocholithiasis patients. The primary outcome was post-ERCP pancreatitis (PEP), while secondary outcomes included post-ERCP cholangitis, bleeding, and perforation. We calculated pooled risk ratios (RR) and 95% confidence intervals (CIs) using the Mantel–Haenszel method within a random-effect model.

Results

Our analysis included six observational studies, totaling 2,178 choledocholithiasis patients (392 asymptomatic and 1786 symptomatic); 53% were female. Asymptomatic patients exhibited a higher risk of PEP compared with symptomatic patients (11.7% versus 4.8%; RR 2.59, 95% CI 1.56–4.31, p ≤ 0.001). No significant difference was observed in post-ERCP cholangitis, bleeding, or perforation rates between the two groups.

Conclusions

Asymptomatic patients with choledocholithiasis appear to have a higher risk of PEP than symptomatic patients, while the risk of other post-ERCP adverse events is similar between the two groups. Interventional endoscopists should thoroughly discuss potential adverse events (particularly PEP) with asymptomatic patients before performing ERCP and utilize PEP-prevention measures more liberally in this subgroup of patients.

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Abbreviations

PEP:

Post-ERCP pancreatitis

ERCP:

Endoscopic retrograde cholangiopancreatography

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA

    Itegbemie Obaitan, Azizullah Beran, Hisham Wehbe, Mohammad Al-Haddad, Jeffrey J. Easler & Evan L. Fogel

  2. Department of Internal Medicine, Warren Alpert Medical School Brown University, Providence, RI, USA

    Mouhand F. H. Mohamed

  3. Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA

    Michael Rosenheck & Neetu Mahendraker

  4. Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA, USA

    Elvis T. Obomanu

  5. Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Tyler M. Berzin

  6. Division of Gastroenterology and Hepatology, University of Utah, Salt Lake City, UT, USA

    Daryl Ramai

  7. Division of Gastroenterology, Bon Secours Mercy Health, Toledo, OH, USA

    Muhammad Aziz

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  1. Itegbemie Obaitan
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Correspondence to Itegbemie Obaitan.

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Obaitan, I., Mohamed, M.F.H., Beran, A. et al. Comparative Risks of Post-ERCP Adverse Events in Patients with Asymptomatic and Symptomatic Choledocholithiasis: A Systematic Review and Meta-Analysis. Dig Dis Sci (2024). https://doi.org/10.1007/s10620-024-08374-0

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