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Journal of Digestive Diseases Dec 2023In patients with acute pancreatitis (AP), minimally invasive treatment and the step-up approach have been widely used to deal with infected pancreatic necrosis (IPN) in... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
In patients with acute pancreatitis (AP), minimally invasive treatment and the step-up approach have been widely used to deal with infected pancreatic necrosis (IPN) in the last decade. It is unclear whether IPN has become a less important determinant of mortality relative to organ failure (OF). We aimed to statistically aggregate recent evidence from published studies to determine the relative importance of IPN and OF as determinants of mortality in patients with AP (PROSPERO: CRD42020176989).
METHODS
Relevant studies were sourced from MEDLINE and EMBASE databases. Relative risk (RR) or weighted mean difference (WMD) was analyzed as outcomes. A two-sided P value of less than 0.05 was regarded as statistical significance.
RESULTS
Forty-three studies comprising 11 601 patients with AP were included. The mortality was 28% for OF patients and 24% for those with IPN. Patients with OF without IPN had a significantly higher risk of mortality compared to those with IPN but without OF (RR 3.72, P < 0.0001). However, patients with both OF and IPN faced the highest risk of mortality. Additionally, IPN increased length of stay in hospital for OF patients (WMD 28.75, P = 0.032).
CONCLUSION
Though IPN remains a significant concern, which leads to increased morbidity and longer hospital stay, it is a less critical mortality determinant compared to OF in AP.
Topics: Humans; Pancreatitis, Acute Necrotizing; Prognosis; Acute Disease; Bacterial Infections; Retrospective Studies
PubMed: 38037512
DOI: 10.1111/1751-2980.13243 -
Jornal de Pediatria 2012To describe the main epidemiological, clinical, diagnostic and treatment aspects of children with acute pancreatitis. (Review)
Review
OBJECTIVE
To describe the main epidemiological, clinical, diagnostic and treatment aspects of children with acute pancreatitis.
SOURCES
Systematic review of MEDLINE and SciELO databases in the last 5 years on acute pancreatitis in children, as well as consultation of relevant references on the texts obtained.
SUMMARY OF THE FINDINGS
Cases of acute pancreatitis in children have received growing attention in recent years, and an increase in the number of cases has been reported in several studies. The main etiologies in children involve biliary disease, drug-induced pancreatitis, recurrent hereditary pancreatitis and trauma, and up to 30% of cases have no defined etiology. The diagnosis is based on the combination of clinical and laboratory aspects with the increase of acinar enzymes and radiologic tests. Initial support treatment, with proper volume replacement and correction of the metabolic disturbances, besides specific nutritional therapy, are the fundamental points in the handling of acute conditions. Long term complications are unusual, and mortality rates are inferior to the rates for the adult population.
CONCLUSION
The early diagnosis and the appropriate handling can contribute to a better outcome for the child with pancreatitis and to prevent the immediate and late complications related to the disease. More studies are required to better explain aspects related to the clinical and radiological diagnosis of pancreatitis in children, as well as aspects related to the nutritional therapy for this age group.
Topics: Acute Disease; Child; Early Diagnosis; Enteral Nutrition; Humans; Pancreatitis
PubMed: 22543443
DOI: 10.2223/JPED.2163 -
Digestive and Liver Disease : Official... Jun 2017To systematically determine the diagnostic value of contrast-enhanced ultrasound (CEUS) in the assessment of acute pancreatitis. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To systematically determine the diagnostic value of contrast-enhanced ultrasound (CEUS) in the assessment of acute pancreatitis.
METHODS
Relevant studies were identified by searching the database up to December 2016. Patient clinical characteristics and diagnostic sensitivity and specificity were extracted. The summary receiver operating characteristic (ROC) curve was used to examine the accuracy of CEUS. A meta-analysis was performed to evaluate the clinical utility in the diagnosis and evaluation of acute pancreatitis.
RESULTS
From 27 citations, seven were included in the meta-analysis, with a total of 421 cases. We detected the heterogeneity of the studies and evidence of publication bias. The methodological quality was moderate. The pooled weighted sensitivity with a corresponding 95% confidence interval (CI) was 0.92 (95% CI: 0.88, 0.95), the specificity was 0.84 (95% CI: 0.78, 0.90), the positive likelihood ratio was 5.38 (95% CI: 3.21, 9.00), the negative likelihood ratio was 0.13 (95% CI: 0.05, 0.36), and the diagnostic odds ratio was 49.37 (95% CI: 14.69, 165.94). The area under the ROC curve was 0.9273 (95% CI: 0.8916, 0.9790).
CONCLUSIONS
CEUS is a reliable, non-invasive imaging modality with no radiation exposure and a high sensitivity and specificity for the assessment of severity of acute pancreatitis. Nonetheless, it should be applied cautiously, and large-scale, well-designed trials are necessary to assess its clinical value.
Topics: Acute Disease; Contrast Media; Humans; Pancreatitis; ROC Curve; Sensitivity and Specificity; Ultrasonography
PubMed: 28462883
DOI: 10.1016/j.dld.2017.03.017 -
Comparison of EUS with MRCP in idiopathic acute pancreatitis: a systematic review and meta-analysis.Gastrointestinal Endoscopy May 2018Idiopathic acute pancreatitis (IAP) poses a diagnostic challenge for gastroenterologists, because confirmation of the disease etiology has important implications for the... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND AND AIMS
Idiopathic acute pancreatitis (IAP) poses a diagnostic challenge for gastroenterologists, because confirmation of the disease etiology has important implications for the selection of the best possible treatment and the prevention of possible recurrence or the development of chronic pancreatitis (CP). ERCP, EUS, and MRCP typically are used to diagnose IAP when conventional radiologic methods fail. However, their exact role in the diagnosis of IAP has not yet been determined.
METHODS
We searched the PubMed, EMBASE, OVID, Cochrane Library (including CENTRAL), China National Knowledge Infrastructure (CNKI), and Wanfang databases from inception to April 2017. Studies involving the use of EUS and/or MRCP for the etiologic diagnosis of IAP were included. A meta-analysis was performed by using Review Manager Version 5.2 for comparative studies and R software 3.3.3 to determine diagnostic yield of the studies.
RESULTS
Among the 34 studies that met the inclusion criteria (n = 2338), 7 studies used a combination of EUS and MRCP and totaled 249 patients. The results comparing EUS with MRCP showed a diagnostic yield of 153 of the 239 patients (64%) in the EUS group, which was higher than the yield of 82 of 238 patients (34%) in the MRCP group (P < .001) in the 7 studies, and the diagnostic yield was 60% in the EUS group, 24% in the MRCP group, and 43% in the MRCP after secretin stimulation (S-MRCP) group. In our subgroup analysis of CP and biliary disease, EUS was superior to MRCP (P < .001), but when comparing the efficacy of the modalities in the diagnosis of pancreatic divisum, S-MRCP was obviously superior to MRCP and EUS (12% vs 2% vs 2%).
CONCLUSION
EUS and MRCP should both be used in the diagnostic work-up of IAP as complementary techniques. EUS had a higher diagnostic accuracy than MRCP (64% vs 34%) in the etiologic diagnosis of IAP and should be preferred for establishing a possible biliary disease and CP diagnosis, whereas S-MRCP was superior to EUS and MRCP in diagnosing a possible anatomic alteration in the biliopancreatic duct system, such as pancreatic divisum.
Topics: Acute Disease; Cholangiopancreatography, Magnetic Resonance; Endosonography; Humans; Pancreas; Pancreatitis; Pancreatitis, Chronic; Recurrence
PubMed: 29225082
DOI: 10.1016/j.gie.2017.11.028 -
HPB : the Official Journal of the... Feb 2023Acute pancreatitis (AP) has variable clinical courses. This systematic review and meta-analysis aimed to determine the safety, efficacy, and impact of epidural... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Acute pancreatitis (AP) has variable clinical courses. This systematic review and meta-analysis aimed to determine the safety, efficacy, and impact of epidural anaesthesia (EA) use in AP.
METHODS
The PubMed, EMBASE, SCOPUS and Cochrane library databases were systematically searched between 1980 and 2022 using the PRISMA guidelines, to identify observational and comparative studies reporting on EA in AP. The meta-analysis was performed in R Foundation for Statistical Computing using the meta R Package for Meta-Analysis.
RESULTS
A total of 9 studies with 2006 patients of which 726 (36%) patients had EA were included. All studies demonstrated high safety and feasibility of EA in AP with no reported major local or neurological complications. One randomised controlled trial demonstrated an improvement in pain severity using a 0-10 visual analogue scale (VAS) at the outset (1.6 in EA vs 3.5 in non-EA, P = 0.02) and on day 10 (0.2 in EA vs 2.33 in non-EA, P = 0.034). There was also improvement in pancreatic perfusion with EA measured with computerised tomography 13 (43%) in EA vs 2 (7%) in non-EA, P = 0.003. The need for ventilatory support and overall mortality was lower in EA patients 40 (19%) vs 285 (24%) P = 0.025 (OR: 0.49, 95% CI: 0.28-0.84) and 16 (7%) vs 214 (20%), P = 0.050 (OR: 0.39, 95% CI: 0.15-1.00), respectively.
CONCLUSION
EA is infrequently used for pain management in AP and yet the available evidence suggests that it is safe and effective in reducing pain severity, improving pancreatic perfusion, and decreasing mortality.
Topics: Humans; Pancreatitis; Acute Disease; Anesthesia, Epidural; Pancreas; Analgesia, Epidural; Randomized Controlled Trials as Topic
PubMed: 36593161
DOI: 10.1016/j.hpb.2022.12.004 -
Pancreatology : Official Journal of the... Mar 2022The timing of oral refeeding can affect length of stay (LOS) and recovery of acute pancreatitis (AP). However, the optimal timing for oral refeeding is still... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The timing of oral refeeding can affect length of stay (LOS) and recovery of acute pancreatitis (AP). However, the optimal timing for oral refeeding is still controversial for AP. This meta-analysis investigated the effects of immediate or early versus delayed oral feeding on mild and moderate AP, regardless of improvement in clinical signs or laboratory indicators.
METHODS
This systematic review and meta-analysis of randomized controlled trials (RCTs) based on data from Embase, Cochrane Library, PubMed, Web of science, and CBM before August 2021. Two researchers independently used Stata16 to extract and analyse study data. Random effect model was performed for meta-analysis to calculate the risk ratio (RR) and standardized mean difference (SMD).
RESULTS
8 RCTs were selected, including 748 patients with mild to moderate AP. Patients in IOR (Immediate or early Oral Refeeding) group had less costs [SMD -0.83, 95%CI (-1.17, -0.5), P < 0.001] and shorter LOS [SMD -1.01, 95%CI (-1.17, -0.85), P < 0.001] than the DOR (Delayed Oral Refeeding) group patients. However, there was no difference in mortality [RR 0.54, 95%CI (0.11, 2.62), P = 0.44], pain relapse rate [RR 0.58, 95%CI (0.25, 1.35), P = 0.27], feeding intolerance rate [RR 0.61, 95%CI (0.28, 1.3), P = 0.2], AP progression rate [RR 0.21, 95%CI (0.04, 1.07), P = 0.06] and overall complications rate [RR 0.41, 95%CI (0.17, 1.01), P = 0.05] between the IOR and DOR groups.
CONCLUSIONS
Limited data suggest that IOR could reduce LOS and costs without increasing adverse events in mild to moderate AP.
Topics: Humans; Length of Stay; Pancreatitis; Recurrence
PubMed: 34876385
DOI: 10.1016/j.pan.2021.11.009 -
Phytotherapy Research : PTR Aug 2018The objective of this study is to evaluate the efficacy and safety of rhubarb combined with trypsin inhibitor for severe acute pancreatitis (SAP). This meta-analysis was... (Meta-Analysis)
Meta-Analysis Review
The objective of this study is to evaluate the efficacy and safety of rhubarb combined with trypsin inhibitor for severe acute pancreatitis (SAP). This meta-analysis was performed in accordance with the Transparent Reporting of Systematic Reviews and Meta-analysis protocol (PRISMA-P) and Cochrane Handbook. Relevant studies from inception to 2016 were searched through 7 related databases. The Cochrane Library was searched to assess the bias of the included trials. Data were analysed with Review Manager 5.3 software. A total of 16 randomized controlled trials (RCTs) involving 912 participants with SAP were included in this meta-analysis. The result showed that when compared with trypsin inhibitor used alone, rhubarb combined with trypsin inhibitor showed intensive effects on decreasing mortality, increasing overall efficacy, shorting length of hospitalization, reducing abdominal pain relief time, and decreasing the level of serum amylase. There was no serious adverse event reported in these RCTs. It should be noted that potential publication bias was observed. This meta-analysis demonstrated that rhubarb combined with trypsin inhibitor could be an effective and safe treatment for patients with SAP. However, the small sample size and poor quality of these RCTs should be noted. And more rigorously designed, multicentre, large-scale worldwide trials with more practitioners and higher quality are required.
Topics: Acute Disease; Humans; Pancreatitis; Plant Preparations; Randomized Controlled Trials as Topic; Rheum; Trypsin Inhibitors
PubMed: 29672966
DOI: 10.1002/ptr.6096 -
The Journal of International Medical... Sep 2023Acute pancreatitis (AP) is a severe complication of leptospirosis. This review focuses on the current evidence of AP in patients with leptospirosis.
OBJECTIVES
Acute pancreatitis (AP) is a severe complication of leptospirosis. This review focuses on the current evidence of AP in patients with leptospirosis.
METHODS
Data on clinical characteristics, biochemical parameters, diagnosis, complications, critical care, fluid management, operative management, and outcomes were analyzed. This study was registered in PROSPERO (CRD42022360802).
RESULTS
We included 35 individual case reports and 4 case series involving 79 patients. Sex was reported for 48 (60.7%) patients; 38 (48.1%) were male and 10 (12.6%) were female. The patients' mean age was 45.13 (15-83 years). Acute kidney injury, thrombocytopenia, hypotension, and liver injury were the most common complications reported. Complete recovery was reported for 36 (45.5%) patients. Biochemical and radiological recovery was reported for 10 (12.6%) and 9 (11.3%) patients, respectively. Death was reported in 18 (22.7%) patients.
CONCLUSION
A high degree of clinical suspicion and different modalities of investigations are essential in the diagnosis of AP in leptospirosis. AP can be easily missed in leptospirosis because both conditions share similar clinical presentations and complications. Because of the high prevalence of acute kidney injury, judicious fluid management and close monitoring are mandatory.
Topics: Humans; Male; Female; Middle Aged; Pancreatitis; Acute Disease; Leptospirosis; Thrombocytopenia; Acute Kidney Injury
PubMed: 37776529
DOI: 10.1177/03000605231197461 -
Medicine Mar 2019The incidence of acute pancreatitis (AP) is rising around the world, thus further increasing the burden on healthcare services. Approximately 20% of AP will develop... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The incidence of acute pancreatitis (AP) is rising around the world, thus further increasing the burden on healthcare services. Approximately 20% of AP will develop severe acute pancreatitis (SAP) with persistent organ failure (>48 h), which is the leading cause of high mortality. To date, there is no specific drug in treating SAP, and the main treatment is still based on supportive care. However, some clinical control studies regarding the superiority of continuous blood purification (CBP) has been published recently. Therefore, we conducted a systematic review and meta-analysis to evaluate the efficacy of CBP in SAP treatment.
METHODS
Four databases (Medline, SinoMed, EMBASE, and Cochrane Library) were searched for eligible studies from 1980 to 2018 containing a total of 4 randomized controlled trials and 8 prospective studies.
RESULTS
After the analysis of data amenable to polling, significant advantages were found in favor of the CBP approach in terms of Acute Physiology and Chronic Health Evaluation II (APACHE II) score (WMD = -3.00,95%CI = -4.65 to -1.35), serum amylase (WMD = -237.14, 95% CI = -292.77 to 181.31), serum creatinine (WMD = -80.54,95%CI = 160.17 to -0.92), length of stay in the ICU (WMD = -7.15,95%CI = -9.88 to -4.43), and mortality (OR = 0.60, 95%CI = 0.38-0.94). No marked differences were found in terms of C-reactive protein (CRP), alamine aminotransferase (ALT) and length of hospital stay (LOS).
CONCLUSION
Compared with conventional treatment, CBP remedy evidently improved clinical outcomes, including reduced incidence organ failure, decreased serum amylase, APACHE II score, length of stay in the ICU and lower mortality rate, leading us to conclude that it is a safer treatment option for SAP. Furthermore, relevant multicenter RCTs are required to prove these findings.
Topics: APACHE; Acute Disease; Hemofiltration; Humans; Inflammation Mediators; Length of Stay; Multiple Organ Failure; Pancreatitis; Prospective Studies
PubMed: 30896634
DOI: 10.1097/MD.0000000000014873 -
Journal of Clinical Gastroenterology Jan 2022We aimed to extract the percent of signs and symptoms at the time of diagnosis from published studies and to pool these using meta-analytic techniques.
GOAL
We aimed to extract the percent of signs and symptoms at the time of diagnosis from published studies and to pool these using meta-analytic techniques.
BACKGROUND
Delayed or misdiagnosis of chronic pancreatitis may occur because the signs and symptoms are nonspecific and varied.
STUDY
We performed a systematic review of studies reporting the signs and symptoms of chronic pancreatitis at diagnosis. The percentage of patients with each sign and symptom was extracted and random-effects meta-analyses used to calculate pooled percentages.
RESULTS
In total, 22 observational studies were included. Across 14 studies, 55% of chronic pancreatitis patients were classified as having alcoholic etiology. Abdominal pain was the most common symptom (76%), and weight loss was reported in 22% of patients. Jaundice occurred in 11% of patients and steatorrhoea in 3%. Half of the patients had a history of acute pancreatitis, and 28% had diabetes mellitus at diagnosis. Heterogeneity between the studies was high for all signs and symptoms.
CONCLUSIONS
This research has identified some common features of patients with chronic pancreatitis, but the high heterogeneity makes it difficult to draw solid conclusions. Carefully designed studies to examine the signs and symptoms leading up to a diagnosis of chronic pancreatitis, and common combinations, are required. These would enable the development of a tool to aid in the early identification of chronic pancreatitis in the primary care setting, with potential for improved short-term and long-term outcomes for patients.
Topics: Acute Disease; Humans; Pancreatitis, Chronic; Primary Health Care; Prodromal Symptoms
PubMed: 34049375
DOI: 10.1097/MCG.0000000000001544