Table.
GRADE Evaluation of interventions for Chronic pancreatitis.
| Important outcomes | Adverse effects, Development of complications, Global symptom improvement, Mortality, Pain relief, Quality of life, Steatorrhoea, Weight gain/maintenance | ||||||||
| Studies (Participants) | Outcome | Comparison | Type of evidence | Quality | Consistency | Directness | Effect size | GRADE | Comment |
| What are the effects of dietary supplements in people with chronic pancreatitis? | |||||||||
| 4 (not reported) | Pain relief | Pancreatic enzyme supplements versus placebo | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for incomplete reporting of results, inclusion of poor-quality RCTs, and no significance assessment between groups |
| 3 (55) | Steatorrhoea | Pancreatic enzyme supplements versus placebo | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and incomplete reporting of results |
| 1 (27) | Global symptom improvement | Pancreatic enzyme supplements versus placebo | 4 | –2 | 0 | –1 | 0 | Very low | Quality points deducted for sparse data and short follow-up. Directness point deducted for use of subjective outcome |
| 2 (56) | Adverse effects | Pancreatic enzyme supplements versus placebo | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and incomplete reporting of results |
| 1 (36) | Pain relief | Oral citrate versus placebo | 4 | –2 | 0 | –1 | 0 | Very low | Quality points deducted for sparse data and incomplete reporting of results. Directness point deducted as only 16 people had pain before trial started |
| What are the effects of drug interventions in people with chronic pancreatitis? | |||||||||
| 1 (25) | Pain relief | Opioid analgesics versus each other | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, short follow-up, and incomplete reporting of results |
| 1 (25) | Adverse effects | Opioid analgesics versus each other | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and incomplete reporting of results |
| What are the effects of nerve blocks for pain relief in people with chronic pancreatitis? | |||||||||
| 1 (18) | Pain relief | Endoscopic ultrasound-guided nerve block versus computerised tomography-guided nerve block | 4 | –2 | 0 | –1 | 0 | Very low | Quality points deducted for sparse data and incomplete reporting of results. Directness point deducted for no between-group analysis for 1 outcome |
| What are the effects of different invasive treatments for specific complications of chronic pancreatitis? | |||||||||
| 2 (111) | Mortality | Endoscopic versus surgical ductal decompression | 4 | –2 | 0 | –1 | 0 | Very low | Quality points deducted for sparse data and for quasi-randomisation in 1 RCT. Directness point deducted for small number of events |
| 3 (1129) | Pain relief | Endoscopic versus surgical ductal decompression | 4 | –3 | 0 | –1 | 0 | Very low | Quality points deducted for incomplete reporting of results, quasi-randomisation in 1 RCT, and inclusion of observational data. Directness point deducted for no direct comparison between groups in 1 study |
| 1 (72) | Weight gain/maintenance | Endoscopic versus surgical ductal decompression | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, quasi-randomisation, and incomplete reporting of results |
| 1 (51) | Mortality | Different types of surgical ductal decompression versus each other | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, poor follow-up, and incomplete reporting of results |
| 1 (51) | Pain relief | Different types of surgical ductal decompression versus each other | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, poor follow-up, and incomplete reporting of results |
| 1 (51) | Quality of life | Different types of surgical ductal decompression versus each other | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, poor follow-up, and incomplete reporting of results |
| 1 (51) | Adverse effects | Different types of surgical ductal decompression versus each other | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, poor follow-up, and incomplete reporting of results |
| 4 (184) | Mortality | Resection using pancreaticoduodenectomy versus other surgical techniques | 4 | –2 | 0 | –2 | 0 | Very low | Quality points deducted for sparse data and inclusion of RCTs with extensive methodological weaknesses. Directness points deducted for no statistical comparison between groups and for small number of events |
| 4 (173) | Pain relief | Resection using pancreaticoduodenectomy versus other surgical techniques | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, low follow-up, and inclusion of RCTs with extensive methodological weaknesses |
| 4 (173) | Weight gain/maintenance | Resection using pancreaticoduodenectomy versus other surgical techniques | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and inclusion of RCTs with extensive methodological weaknesses |
| 2 (101) | Quality of life | Resection using pancreaticoduodenectomy versus other surgical techniques | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and incomplete reporting of results |
| 4 (184) | Adverse effects | Resection using pancreaticoduodenectomy versus other surgical techniques | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and incomplete reporting of results |
We initially allocate 4 points to evidence from RCTs, and 2 points to evidence from observational studies. To attain the final GRADE score for a given comparison, points are deducted or added from this initial score based on preset criteria relating to the categories of quality, directness, consistency, and effect size. Quality: based on issues affecting methodological rigour (e.g., incomplete reporting of results, quasi-randomisation, sparse data [<200 people in the analysis]). Consistency: based on similarity of results across studies. Directness: based on generalisability of population or outcomes. Effect size: based on magnitude of effect as measured by statistics such as relative risk, odds ratio, or hazard ratio.