Summary of findings for the main comparison. Pancreatic duct guidewire (PGW) or double guidewire technique (DGT) compared to other endoscopic techniques for the prevention of post‐endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis.
| Pancreatic duct guidewire (PGW) or double guidewire technique (DGT) compared to other endoscopic techniques for the prevention of post‐endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis | |||||
| Patient or population: people with biliary cannulation for the prevention of post‐ERCP pancreatitis Settings: hospital Intervention: PGW or DGT Comparison: other endoscopic techniques | |||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | |
| Assumed risk | Corresponding risk | ||||
| Other endoscopic techniques | PGW or DGT | ||||
| Post‐ERCP pancreatitis | 80 per 1000 | 158 per 1000 (91 to 273) | RR 1.98 (1.14 to 3.42) | 577 (7 studies) | ⊕⊕⊝⊝ low1,2,3 |
| PGW vs persistent attempts with conventional cannulation technique | |||||
| 87 per 1000 | 137 per 1000 (72 to 261) | RR 1.58 (0.83 to 3.01) | 305 (3 studies) | ⊕⊕⊝⊝ low1,2,3 | |
| PGW vs precut sphincterotomy | |||||
| 103 per 1000 |
302 per 1000 (128 to 712) |
RR 2.92 (1.24 to 6.88) | 115 (2 studies) | ⊕⊕⊝⊝ low1,2,3 | |
| PGW vs PD stent placement | |||||
| 50 per 1000 | 88 per 1000 (4 to 1000) | RR 1.75 (0.08 to 37.5) | 157 (2 studies) | ⊕⊝⊝⊝ very low1,2,3,4 | |
| CBD cannulation success with the randomised technique (before the use of rescue techniques) | 663 per 1000 | 690 per 1000 (577 to 822) | RR 1.04 (0.87 to 1.24) | 577 (7 studies) | ⊕⊕⊝⊝ low1,5 |
| Overall cannulation success | 816 per 1000 | 849 per 1000 (743 to 963) | RR 1.04 (0.91 to 1.18) | 577 (7 studies) | ⊕⊕⊝⊝ low1,6 |
| Post‐ERCP bleeding | 35 per 1000 | 17 per 1000 (5 to 63) | RR 0.48 (0.13 to 1.79) | 513 (6 studies) | ⊕⊕⊝⊝ low1,2 |
| Post‐ERCP perforation | 4 per 1000 | 4 per 1000 (0 to 58) | RR 0.94 (0.06 to 14.78) | 513 (6 studies) | ⊕⊕⊝⊝ low1,2 |
| Post‐ERCP cholangitis | 16 per 1000 | 44 per 1000 (13 to 152) | RR 2.71 (0.79 to 9.35) | 373 (4 studies) | ⊕⊕⊝⊝ low1,2 |
| Mortality | 8 per 1000 | 2 per 1000 (0 to 60) | RR 0.31 (0.01 to 7.58) | 258 (2 studies) | ⊕⊕⊝⊝ low1,2 |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CBD: common bile duct; CI: confidence interval; PD: pancreatic duct; PEP: post‐ERCP pancreatitis;RR: risk ratio | |||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | |||||
1Downgraded one level due to limitations in the study design. Most information is obtained from studies with unclear risk of bias for blinding of participants and personnel (other than the endoscopists). Inability to blind the endoscopists may have an impact on the rates of PEP depending on the preference and expertise of the endoscopist performing the procedure. 2Downgraded one level due to imprecision. The results of the main analysis for the outcome of PEP appeared to be imprecise with wide confidence intervals. 3We could not assess publication bias because of less than 10 included studies. Given the complexity of intervention trials involving ERCP, there may not be many unpublished trials. However, publication bias could be present as negative studies may not be published.
4Downgraded one level due to significant unexplained heterogeneity (I2 = 76%).
5Downgraded one level due to significant heterogeneity (I2 = 63%).
6Downgraded one level due to significant heterogeneity (I2 = 66%).
*The assumed risk is based on the mean baseline risk from the studies in the control group in this meta‐analysis. This is obtained by dividing the total number of events in the control groups by the total number of participants in the control groups.