Early biliary decompression in predicted severe acute pancreatitis – the APEC trial

Currently available guidelines clearly recommend early ERCP (endoscopic retrograde cholangiography) in acute biliary pancreatitis with concomitant cholangitis.

There is however lack of evidence for the role of routine early ERCP + sphincterotomy in patients without cholangitis, and this was the rationale for the APEC trial, conducted by the Dutch Pancreatitis Study Group.

The APEC trial was designed as a randomized controlled, superiority multicenter trial meant to assess the outcome of patients with acute biliary pancreatitis without cholangitis who get ERCP + sphincterotomy compared to those who get conservative treatment. The primary endpoint was a composite of major complications (that is, organ failure, pancreatic necrosis, pneumonia, bacteremia, cholangitis, pancreatic endocrine, or exocrine insufficiency) or death within 180 days after randomization.

1178 patients were assessed for eligibility, 232 underwent randomization and 230 were included in the final analysis. The study concluded that early ERCP was not associated with better outcomes in these patients with predicted severe AP without cholangitis, except a reduced incidence of cholangitis.

Results were presented during the Opening Plenary Session at UEGW 2018 in Vienna.

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