The Effect Of Different Interventional Therapies In Patients With Severe Acute Pancreatitis:a Meta-analysis

Objective:This study by the Meta analysis was to compare therapeutic effect of theree interventional therapies in patients with Severe Acute Pancreatitis(SAP),including percutaneous catheter drainage(PCD),peritoneal lavage,regional arterial infusion(RAI),to obtain the optimal treatment and accumulate experience of SAP.Methods:By the retrieval of the WanFang,CNKI,CBM,Embase,PUBMED,Cochrane Library,Google Scholar databases,we included all randomized controlled trials about PCD,CRAI and peritoneal lavage to treat SAP.The objects of all studies were adults with SAP.Treatment groups were mainly on the basis of general internal medicine with PCD,CRAI and peritoneal lavage,the control groups with conservative treatment or surgery.The main outcomes incuded the overall efficiency and fatality rate.The secondary outcomes had the total length of hospital staying,complication rate,transit operation rate,abdominal pain and distension relief time,bowel sounds recovery time,amylase in blood and urine recovery time.We used RR,MD,and 95% confidence interval to evaluate different interventional therapies,according I2 to do heterogeneity analysis.Using the fixed effects or random effects model analysis depended on I2.We made sensitivity analysis and assessed publication bias by funnel chart.Results:PCD compared to conventional treatment could effectively reduce fatality rate(RR0.25,95%CI 0.12-0.54,P=0.0005),complication rates,transit operation rates,shortening hospital staying,bowel sounds recovery time,amylase in blood and urine recovery time,but the overall efficiency(RR 1.36,95%CI 0.98-1.88,P=0.06),abdominal pain anddistension relief time were no different from the control group;PCD compared with surgical treatment,PCD significantly enhanced the overall efficiency(RR 1.33,95%CI1.15-1.53,P<0.0001),reducing the fatality rate(RR 0.17,95%CI 0.07-0.39,P<0.0001)and complication rates,shortening hospitalization time,abdominal pain and distension recovery time,amylase in blood and urine recovery time;CRAI compared to conventional treatment,CRAI enhanced the overall efficiency(RR 1.23,95%CI1.12-1.34,P<0.00001)and reduced the fatality rate(RR 0.18,95%CI0.07-0.44,P=0.0001),transit operation rate,complication rates,shortening the hospitalization time,abdominal pain and distension relief time,amylase in blood and urine recovery time;Peritoneal lavage compared to conventional treatment,peritoneal lavage conld improve the overall efficiency(RR 1.20,95%CI 1.11-1.29,P<0.00001)and reduce the fatality rate(RR 0.51,95%CI 0.32-0.82,P=0.005),transit operation rate,complication rate,shortening the hospitalization time and amylase in blood recovery time.But abdominal pain and distention,bowel sounds recovery time were no different from the control group;In terms of benefit,PCD(3620 per ten thousand people benefit)had the most benefit,followed by CRAI(2540 per ten thousand people benefit)and peritoneal lavage(2390 per ten thousand people benefit);Sensitivity analysis found that the direction of merged results were not be changed after removing the various studies,proving the merged results reliable;Publication bias assessment found that mortality about PCD compared to conventional treatment of funnel figure showed corner missing characterized by asymmetric,there may be a publication bias.Conclusion:PCD,CRAI,peritoneal lavage could not only enhance the overall efficiency,reducing the fatality rate,transit operation rate and complications rate,but also shorten the length of hospital staying,amylase in blood and urine recovery time.The overall benefit of the PCD was more than CRAI and peritoneal lavage.But the number included in the literature was so difficient,more large study datas were required to gain a higher quality of evidence in this study.