ERCP versus conservative treatment in acute pancreatitis: Meta-analysis or meta-confusion?

摘要

I write to the journal to express my concerns with regard to the recently published article by Moretti et al. , Having statistically aggregated the results from five randomized controlled trials (RCTs) on early endoscopic retrograde cholangiopancreatography (ERCP) versus conservative management in acute pancreatitis, the authors concluded that "early ERCP reduces pancreatitis-related complications in patients with predicted severe pancreatitis". I cannot agree with this inference due to several reasons.Firstly, notwithstanding that "all articles passed through a multilevel, systematic review by a team of four physicians", the presentation of the data on characteristics of the primary studies was inaccurate: acute cholangitis was not an exclusion criterion in the trial by Fan et al. , ERCP was not started within 72 h of admission in the RCT by Oria et al. and conservative management did include a traditional Chinese medicine in the study by Zhou et al. . These facts debunk the illusion of clinical homogeneity among the trials in Table 1 of the article by Moretti and co-authors.