Studies were eligible for this review if they used randomisation to allocate patients with acute biliary pancreatitis but no acute cholangitis to one of the following treatment groups: early endoscopic retrograde cholangiopancreatography within 72 hours with or without endoscopic sphincterotomy; and conservative treatment with selective endoscopic retrograde cholangiopancreatography with or without endoscopic sphincterotomy. The outcomes of interest were rates of mortality and overall complications.
Included studies were all randomised controlled trials (RCTs) of patients with acute biliary pancreatitis without acute cholangitis; where trials included patients with acute cholangitis these data were presented separately. Only one trial was multicentre and the rest were single centre. Trials used different criteria to establish cholangitis (bilirubin levels, Charcot's triad or not stated). Early endoscopic retrograde cholangiopancreatography was given either within 48 hours or 72 hours of admission or onset. Patient ages in the early endoscopic retrograde cholangiopancreatography groups ranged from 20 to 90 years and in the conservative treatment groups from 15 to 96 years. The balance of females ranged from 52% to 69% in the early endoscopic retrograde cholangiopancreatography group and from 56% to 75% in the conservative treatment group. Trials reported mortality rates and overall complications; the latter was defined differently in each included study.
Study selection was performed by two reviewers working independently. Any discrepancies were resolved by discussion.