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CC BY-NC-ND 4.0 · Journal of Gastrointestinal Infections 2023; 13(01): 017-025
DOI: 10.1055/s-0043-1768701
Systematic Review

Systematic Review and Meta-Analysis: Risk of Post-ERCP Cholangitis with Air or CO2 versus Contrast Cholangiography in Perihilar Malignant Biliary Obstruction

Suprabhat Giri 
1   Department of Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
,
Sidharth Harindranath
2   Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
,
Prajna Anirvan 
3   Department of Gastroenterology, All India Institute of Medical Science Bhubaneswar, Bhubaneswar, Orissa, India
,
Lohith Kumar
1   Department of Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
,
Sridhar Sundaram 
4   Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Abstract

Background Endoscopic retrograde cholangiopancreatography (ERCP) may be associated with a risk of postprocedural cholangitis in case of failed drainage of the injected contrast. The present meta-analysis was conducted to assess whether air cholangiography reduces the risk of post-ERCP cholangitis compared with contrast injection.

Methods A comprehensive search of MEDLINE, EMBASE, and Science Direct from inception to September 2022 was done for studies comparing air or CO2 and contrast agent for cholangiography during ERCP, with the last search on September 31, 2022. Dichotomous outcomes were analyzed using risk ratios (RRs) with 95% confidence intervals (CIs).

Results A total of seven studies were included in the final analysis. Among these, there were three randomized trials and four retrospective studies. The included studies had moderate to high risk of bias. There was no difference in the clinical success rate (RR: 1.02, 95% CI: 0.94–1.09; I 2 = 0%), but a lower risk of all-cause adverse events (AEs) (RR: 0.21, 95% CI: 0.12–0.36; I 2 = 0%) with air cholangiography, compared with contrast cholangiography. Concerning individual AEs, this difference was seen only for cholangitis (RR: 0.51, 95% CI: 0.37–0.69; I 2 = 0%) but not for post-ERCP pancreatitis, perforation, and bleeding. Reintervention and 30-day mortality remained comparable between groups. The certainty of evidence remained low to very low.

Conclusion Air or CO2 cholangiography reduces the risk of overall AE, especially post-ERCP cholangitis, compared with contrast cholangiography. Further trials are required to validate the findings of the study.

Keywords

ERCP - cholangitis - air cholangiography - Klatskin tumor - meta-analysis

Authors' Contribution

Conceptualization: S.G., S.S.; Data curation: S.G., S.H., P.A.; Formal analysis: S.G., S.H., P.A., L.K.; Funding acquisition: N/A; Investigation: S.G., S.H., L.K.; Methodology: S.G., S.H., P.A., S.S.; Project administration: S.G., S.S.; Resources: S.G., S.H., S.S.; Software: S.G.; Supervision: S.S.; Validation: S.G., S.H., S.S.; Visualization: S.G.; Roles/Writing - original draft: S.G., S.H., P.A.; Writing - review & editing: S.G., S.H., P.A., L.K., S.S.


Supplementary Material



Publication History

Received: 22 February 2023

Accepted: 05 April 2023

Article published online:
22 September 2023

© 2023. Gastroinstestinal Infection Society of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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