Early precut sphincterotomy and the risk of endoscopic retrograde cholangiopancreatography related complications: An updated meta-analysis

Figure 1 Flow chart demonstrating the literature search for the meta-analysis.

Figure 2 Overall complications. A: Overall complication rates of the two groups are shown in forest plot. The overall complication rates, considering pancreatitis, perforation, bleeding, and cholangitis rates, were 6.2% (30 cases out of 481 patients) in precut group and 6.9% (39 cases out of 558 patients) in persistent attempts group. The pooled analysis did not show any statistically significant difference between the two groups with an OR 0.85 (95%CI: 0.51-1.41); B: The overall complication rates after excluding studies where direct pre-cut was performed. The results were unchanged. EPC: Early pre cut; PA: Persistent attempts.

Figure 3 Overall post-endoscopic retrograde cholangiopancreatography pancreatitis. A: Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis rates of the two groups are shown in Forest plot. The risk for post-ERCP pancreatitis was 3.9% (19 cases out of 481 patients) in precut group and 6.1 % (34 cases out of 558 patients) in the persistent attempts group. The pooled analysis did not show any statistically significant difference between the two groups with an OR 0.59 (95%CI: 0.32-1.07); B: The overall post-ERCP pancreatitis rates after excluding studies where direct pre-cut was performed. The results were unchanged. EPC: Early pre cut; PA: Persistent attempts.

Figure 4 Overall cannulation rates. A: Cannulation rates of the two groups are shown in Forest plot. The overall cannulation rate was found to be 90% in pre-cut sphincterotomy group and 86.3% in persistent attempts group. The pooled analysis did not show any significant difference between the two groups with an OR 1.98 (95%CI: 0.70-5.65); B: The overall cannulation rates after excluding studies where direct pre-cut was performed. The results were unchanged. EPC: Early pre cut; PA: Persistent attempts.

Figure 5 Funnel plot of overall complication and post-endoscopic retrograde cholangiopancreatography pancreatitis rates confirms that publication bias is not a major determinant of pooled diagnostic accuracy in this meta-analysis.