Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, Rome, Italy.
Scand J Gastroenterol. 2024 Jan-Jun;59(2):225-231. doi: 10.1080/00365521.2023.2266079. Epub 2024 Jan 30.
Pancreas divisum (PD) is a congenital variant of the pancreatic ductal system and a potential cause of acute recurrent pancreatitis (ARP). Endoscopic minor papilla sphincterotomy (MiES) is the most common procedure performed in the management of PD-related ARP. The aim of this study is to perform a meta-analysis estimating the efficacy and the safety of MiES in the management of patients with PD-related ARP.
A research was performed in Pubmed, EMBASE and Web of science, the studies were reviewed and selected according to inclusion and exclusion criteria. Evaluation of Heterogeneity and publication bias was performed, and a random effect model was used to estimate the effect size of each study.
One hundred and thirteen articles were selected and reviewed, 13 met the inclusion criteria. All the studies were retrospective with a mean follow-up duration of 45.9 months. A total of 323 patients with PD-related ARP treated with MiES were included in the meta-analysis. The overall clinical success rate of MiES (defined as no further episodes of ARP, reduction of episodes of ARP, or improvement in quality of life) was of 77% (95%CI: 72%-81%; = 0.30). Evaluating only the studies with clinical success rate defined as "no further AP in the follow-up" the clinical success rate was of 69.8% (95%CI: 61.3%-77.2%; = 0.57), while evaluating the studies with other definitions (reduction of episodes of ARP or improvement in quality of life) the clinical success rate was of 81.2% (95%CI: 75.2%-86.1%; = 0.45). The common fixed effects model disclosed a 25.5% overall adverse events rate (95%CI: 19.3%-32.8%; = 0.42): acute pancreatitis in 14.3% (95%CI: 9.7%-20.6%; = 0.36), bleeding in 5.6% (95%CI: 2.9%-10.4%; = 0.98), and other adverse events in 5.6% (95%CI: 2.9%-10.4%; = 0.67).
MiES is an effective and relatively safe treatment in the management of PD-related ARP. The retrospective nature of the studies selected is the main limitations of this metanalysis. Prospective trials are needed to confirm these data.
胰腺分裂症（PD）是胰腺导管系统的先天性变异，也是急性复发性胰腺炎（ARP）的潜在原因。内镜下胰管小乳头括约肌切开术（MiES）是治疗 PD 相关 ARP 的最常见方法。本研究的目的是进行荟萃分析，估计 MiES 治疗 PD 相关 ARP 的疗效和安全性。
在 Pubmed、EMBASE 和 Web of science 上进行了研究，根据纳入和排除标准对研究进行了审查和选择。评估了异质性和发表偏倚，并使用随机效应模型估计了每项研究的效应量。
共筛选出 113 篇文章，其中 13 篇符合纳入标准。所有研究均为回顾性研究，平均随访时间为 45.9 个月。共纳入 323 例 PD 相关 ARP 患者接受 MiES 治疗。MiES 的总体临床成功率（定义为无 ARP 发作、ARP 发作减少或生活质量改善）为 77%（95%CI：72%-81%；=0.30）。仅评估临床成功率定义为“随访中无 AP”的研究，临床成功率为 69.8%（95%CI：61.3%-77.2%；=0.57），而评估其他定义（ARP 发作减少或生活质量改善）的研究，临床成功率为 81.2%（95%CI：75.2%-86.1%；=0.45）。固定效应模型显示总体不良事件发生率为 25.5%（95%CI：19.3%-32.8%；=0.42）：急性胰腺炎 14.3%（95%CI：9.7%-20.6%；=0.36）、出血 5.6%（95%CI：2.9%-10.4%；=0.98）和其他不良事件 5.6%（95%CI：2.9%-10.4%；=0.67）。
MiES 是治疗 PD 相关 ARP 的一种有效且相对安全的治疗方法。本荟萃分析纳入的研究主要为回顾性研究，这是其主要局限性。需要前瞻性试验来证实这些数据。
