Early endoscopic retrograde cholangiopancreatography in predicted severe XXXX : a prospective multicenter study.

@entity1 @entity788 @entity656 @entity39 @entity648 @entity1448 @entity255
SUMMARY BACKGROUND DATA: The role of early endoscopic retrograde cholangiopancreatography (ERCP) in @entity656 ( @entity656 ) remains controversial. Previous studies have included only a relatively small number of @entity1 with predicted severe @entity656 . We investigated the clinical effects of early ERCP in these @entity1 . METHODS: We performed a prospective, observational multicenter study in 8 university medical centers and 7 major teaching hospitals. One hundred fifty-three @entity1 with predicted severe @entity656 without @entity255 enrolled in a randomized multicenter trial on probiotic prophylaxis in acute @entity788 were prospectively followed. Conservative treatment or ERCP within 72 hours after symptom onset (at discretion of the treating physician) were compared for complications and mortality. @entity1 without and with @entity1448 ( @entity648 : >2.3 mg/dL [40 mumol/L] and/or dilated common bile duct) were analyzed separately. RESULTS: Of the 153 @entity1 , 81 (53%) underwent ERCP and 72 (47%) conservative treatment. Groups were highly comparable at baseline. Seventy-eight @entity1 (51%) had @entity1448 . In @entity1 with @entity1448 , ERCP (52/78 @entity1 : 67%), as compared with conservative treatment, was associated with fewer complications (25% vs. 54%, P = 0.020, multivariate adjusted odds ratio [OR]: 0.35, 95% confidence interval [CI]: 0.13-0.99, P= 0.049). This included fewer @entity1 with >30% pancreatic @entity39 (8% vs. 31%, P = 0.010). Mortality was nonsignificantly lower after ERCP (6% vs. 15%, P = 0.213, multivariate adjusted OR: 0.44, 95% CI: 0.08-2.28, P = 0.330). In @entity1 without @entity1448 , ERCP (29/75 @entity1 : 39%) was not associated with reduced complications (45% vs. 41%, P = 0.814, multivariate adjusted OR: 1.36; 95% CI: 0.49-3.76; P = 0.554) or mortality (14% vs. 17%, P = 0.754, multivariate adjusted OR: 0.78; 95% CI: 0.19-3.12, P = 0.734). CONCLUSIONS: Early ERCP is associated with fewer complications in predicted severe @entity656 if @entity1448 is present.
