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Intervenciones farmacológicas para la pancreatitis aguda

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Referencias

Abraham 2013 {published data only}

Abraham P, Rodriques J, Moulick N, Dharap S, Chafekar N, Verma PK, et al. Efficacy and safety of intravenous ulinastatin versus placebo along with standard supportive care in subjects with mild or severe acute pancreatitis. Journal of the Association of Physicians of India 2013;61(8):535‐8. CENTRAL

Balldin 1983 {published data only}

Balldin G, Borgström A, Genell S, Ohlsson K. The effect of peritoneal lavage and aprotinin in the treatment of severe acute pancreatitis. Research in Experimental Medicine. Zeitschrift für die Gesamte Experimentelle Medizin Einschliesslich Experimenteller Chirurgie 1983;183(3):203‐13. CENTRAL

Bansal 2011 {published data only}

Bansal D, Bhalla A, Bhasin DK, Pandhi P, Sharma N, Rana S, et al. Safety and efficacy of vitamin‐based antioxidant therapy in patients with severe acute pancreatitis: a randomized controlled trial. Saudi Journal of Gastroenterology: Official Journal of the Saudi Gastroenterology Association 2011;17(3):174‐9. CENTRAL

Barreda 2009 {published data only}

Barreda L, Targarona Modena J, Milian W, Portugal J, Sequeiros J, Pando E, et al. Is the prophylactic antibiotic therapy with imipenem effective for patients with pancreatic necrosis? [Es la antibioticoterapia profilactica con Imipenem efectiva en los pacientes con necrosis pancreatica?]. Acta Gastroenterologica Latinoamericana 2009;39(1):24‐9. CENTRAL

Berling 1994 {published data only}

Berling R, Borgstrom A, Ohlsson K. Peritoneal lavage with aprotinin in patients with severe acute pancreatitis: effects on plasma and peritoneal levels of trypsin and leukocyte proteases and their major inhibitors. International Journal of Pancreatology 1998;24(1):9‐17. CENTRAL
Berling R, Genell IS, Ohlsson K. High‐dose intraperitoneal aprotinin treatment of acute severe pancreatitis: a double‐blind randomized multi‐center trial. Journal of Gastroenterology 1994;29(4):479‐85. CENTRAL
Berling R, Ohlsson K. Effects of high‐dose intraperitoneal aprotinin treatment on complement activation and acute phase response in acute severe pancreatitis. Journal of Gastroenterology 1996;31(5):702‐9. CENTRAL

Besselink 2008 {published data only}

Besselink MG, van Santvoort HC, Boermeester MA, Fischer K, Renooij W, de Smet MB, et al. Intestinal barrier dysfunction in a randomised placebo‐controlled trial of probiotic prophylaxis in acute pancreatitis. European Journal of Gastroenterology & Hepatology 2009;21(3):A2‐A. CENTRAL
Besselink MG, van Santvoort HC, Buskens E, Akkermans LM, Gooszen HG, Dutch Acute Pancreatitis Study Group. Probiotic prophylaxis in predicted severe acute pancreatitis ‐ reply. Lancet 2008;372(9633):114. CENTRAL
Besselink MG, van Santvoort HC, Buskens E, Boermeester MA, Goor H, Timmerman HM, et al. Dutch Acute Pancreatitis Study Group. Probiotic prophylaxis in predicted severe acute pancreatitis: a randomised, double‐blind, placebo‐controlled trial. Erratum in: Lancet 2008;371(9620):1246. Lancet 2008;371(9613):651‐9. CENTRAL
Besselink MG, van Santvoort HC, Buskens E, Boermeester MA, van Goor H, Timmerman HM, et al. Probiotic prophylaxis in patients with predicted severe acute pancreatitis: a randomised, double‐blind, placebo‐controlled trial [Probioticaprofylaxe bij voorspeld ernstige acute pancreatitis: een gerandomiseerde, dubbelblinde, placebogecontroleerde trial.]. Nederlands Tijdschrift voor Geneeskunde 2008;152(12):685‐96. CENTRAL
Besselink MG, van Santvoort HC, Buskens E, Boermeester MA, van Goor H, Timmerman HM, et al. Probiotic prophylaxis in predicted severe acute pancreatitis: a randomised, double‐blind, placebo‐controlled trial. European Journal of Gastroenterology & Hepatology 2009;21(3):A8‐9. CENTRAL
Besselink MG, van Santvoort HC, Buskens E, Boermeester MA, van Goor H, Timmerman HM, et al. Dutch Acute Pancreatitis Study Group. Probiotic prophylaxis in predicted severe acute pancreatitis: a randomised, double‐blind, placebo‐controlled trial. Lancet 2008;371(9613):651‐9. CENTRAL
Besselink MG, van Santvoort HC, Renooij W, Smet MB, Boermeester MA, Fischer K, et al. Intestinal barrier dysfunction in a randomized trial of a specific probiotic composition in acute pancreatitis. Annals of Surgery 2009;250(5):712‐9. CENTRAL
Besselink MGH, Timmerman HM, Buskens E, Nieuwenhuijs VB, Akkermans LMA, Gooszen HG. Probiotic prophylaxis in patients with predicted severe acute pancreatitis (propatria): design and rationale of a double‐blind, placebo controlled randomised multicenter trial [ISCRTN 38327949]. BMC Surgery 2004;4:12. CENTRAL
Besselink MGH, van Santvoort HC, Buskens E, Boermeester MA, Dutch Acute Pancreatitis Study Group. Probiotic prophylaxis in predicted severe acute pancreatitis: a randomised, double‐blind, placebo‐controlled trial. Lancet 2008;371(9620):1246. CENTRAL
The Editors of The Lancet. Expression of concern‐probiotic prophylaxis in predicted severe acute pancreatitis: a randomised, double‐blind, placebo‐controlled trial. Lancet 2010;375(9718):875‐6. CENTRAL

Birk 1994 {published data only}

Birk D, Schoenberg MH, Adler G, Beger HG. Oxidative stress in acute‐pancreatitis ‐ results of a prospective randomized clinical pilot‐study. Gastroenterology 1994;106(4):A286‐A. CENTRAL

Bredkjaer 1988 {published data only}

Bredkjaer HE, Bülow S, Ebbehøj N, Friis J, Lindewald H, Rasmussen SG, et al. Treatment of acute pancreatitis with indomethacin. A controlled study of the formation of pseudocysts and their subsequent course [Indometacinbehandling ved pancreatitis acuta. En kontrolleret undersogelse af forekomst og forlob af pseudocystedannelse]. Ugeskrift for Laeger 1988;150(47):2902‐3. CENTRAL

Buchler 1993 {published data only}

Buchler M, Malfertheiner P, Uhl W, Scholmerich J, Stockmann F, Adler G, et al. Gabexate mesilate in human acute pancreatitis. German pancreatitis study group. Gastroenterology 1993;104(4):1165‐70. CENTRAL
Buchler M, Malfertheiner P, Uhl W, Scholmerich J, Stockmann F, Adler G, et al. Gabexate‐mesilate in human acute pancreatitis: results from the German multicenter trial with 4 g/day [abstract]. Digestion 1990;46(3):130. CENTRAL

Chen 2000 {published data only}

Chen HM, Chen JC, Hwang TL, Jan YY, Chen MF. Prospective and randomized study of gabexate mesilate for the treatment of severe acute pancreatitis with organ dysfunction. Hepato‐Gastroenterology 2000;47(34):1147‐50. CENTRAL

Chen 2002a {published data only}

Chen SY, Wang JY. Ulinastatin in the treatment of acute pancreatitis: a multicenter clinical trial. Chinese Journal of Digestive Diseases 2002;3(2):70‐4. CENTRAL

Chen 2002b {published data only}

Chen SY, Wang JY. Ulinastatin in the treatment of acute pancreatitis: a multicenter clinical trial. Chinese Journal of Digestive Diseases 2002;3(2):70‐4. CENTRAL

Choi 1989 {published data only}

Choi TK, Mok F, Zhan WH, Fan ST, Lai EC, Wong J. Somatostatin in the treatment of acute pancreatitis: a prospective randomised controlled trial. Gut 1989;30(2):223‐7. CENTRAL

Chooklin 2007 {published data only}

Chooklin S, Vatseba R. N‐acetylcysteine and dexamethasone in the prevention of respiratory complications in acute pancreatitis [abstract]. European Respiratory Journal 2007;30(Suppl 51):51s [E470]. CENTRAL

Debas 1980 {published data only}

Debas HT, Hancock RJ, Soon‐Shiong P. Glucagon therapy in acute pancreatitis: prospective randomized double‐blind study. Canadian Journal of Surgery 1980;23(6):578‐80. CENTRAL

Delcenserie 1996 {published data only}

Delcenserie R, Yzet T, Ducroix JP. Prophylactic antibiotics in treatment of severe acute alcoholic pancreatitis. Pancreas 1996;13(2):198‐201. CENTRAL

Delcenserie 2001 {published data only}

Delcenserie R, Dellion‐Lozinguez MP, Pagenault M, Hastier P, Yzet T, Dupas JL, et al. Prophylactic ciprofloxacin treatment in acute necrotizing pancreatitis: a prospective randomized multicenter clinical trial. Gastroenterology 2001;120(5):A25‐A. CENTRAL

Dellinger 2007 {published data only}

Dellinger EP, Tellado JM, Soto NE, Ashley SW, Barie PS, Dugernier T, et al. Early antibiotic treatment for severe acute necrotizing pancreatitis: a randomized, double‐blind, placebo‐controlled study. Annals of Surgery 2007;245(5):674‐83. CENTRAL
Dellinger EP, Tellado JM, Soto NE, Ashley SW, Barie PS, Dugernier T, et al. Re: Early antibiotic treatment for severe acute necrotizing pancreatitis ‐ reply. Annals of Surgery 2008;247(2):394‐5. CENTRAL

Dürr 1978 {published data only}

Dürr HK, Kunz R, Zelder O. The treatment of acute pancreatitis with glucagon: a double blind study. Archives Francaises des Maladies de l'Appareil Digestif 1975;64(7 Suppl 4):349. CENTRAL
Dürr HK, Maroske D, Zelder O, Bode Ch J. Glucagon therapy in acute pancreatitis. Report of a double‐blind trial. Gut 1978;19(3):175‐9. CENTRAL
Dürr HK, Zelder O, Maroske D, Bode JC. Treatment of acute pancreatitis with glucagon. Report on a double blind study [Zur behandlung der akuten pankreatitis mit glucagon. Bericht über eine doppelblindstudie]. Verhandlungen der Deutschen Gesellschaft für Innere Medizin 1976;82 Pt 1:970‐3. CENTRAL

Ebbehøj 1985 {published data only}

Ebbehøj N, Bülow S, Friis J, Madsen P, Svendsen LB. Indomethacin treatment of acute pancreatitis. Scandinavian Journal of Gastroenterology Supplement 1984;19(Suppl 98):36. CENTRAL
Ebbehøj N, Friis J, Svendsen B. Indomethacin treatment of acute pancreatitis. A controlled double‐blind trial. Scandinavian Journal of Gastroenterology 1985;20(7):798‐800. CENTRAL

Finch 1976 {published data only}

Finch WT, Sawyers JL, Schenker S. A prospective study to determine the efficacy of antibiotics in acute pancreatitis. Annals of Surgery 1976;183(6):667‐71. CENTRAL

Freise 1986 {published data only}

Freise J, Melzer P. Foy in the treatment of acute‐pancreatitis ‐ results of the Hannover multicentric double‐blind‐study with 50 patients. Zeitschrift Für Gastroenterologie 1985;23(9):429. CENTRAL
Freise J, Melzer P, Schmidt FW, Horbach L. Gabexate mesilate in the treatment of acute pancreatitis ‐ results of the Hannover multicenter double‐blind trial with 50 patients [Gabexat mesilat in der behandlung der akuten pankreatitis. Ergebnisse der hannoverschen multizentrischen doppelblindstudie mit 50 patienten]. Zeitschrift Fur Gastroenterologie 1986;24(4):200‐11. CENTRAL

Frulloni 1994 {published data only}

Frulloni L, Bassi C, Bovo P, Falconi M, Di Francesco V, Pederzoli P, et al. Gabexate mesilate vs aprotinin in the treatment of acute necrotizing pancreatitis. Argomenti di Gastroenterologia Clinica 1994;7(1):31‐6. CENTRAL

Garcia‐Barrasa 2009 {published data only}

Garcia‐Barrasa A, Borobia FG, Pallares R, Jorba R, Poves I, Busquets J, et al. A double‐blind, placebo‐controlled trial of ciprofloxacin prophylaxis in patients with acute necrotizing pancreatitis. Journal of Gastrointestinal Surgery 2009;13(4):768‐74. CENTRAL

Gilsanz 1978 {published data only}

Gilsanz V, Oteyza CP, Rebollar JL. Glucagon vs anticholinergics in the treatment of acute pancreatitis. A double‐blind controlled trial. Archives of Internal Medicine 1978;138(4):535‐8. CENTRAL

Gjørup 1992 {published data only}

Gjørup I, Roikjaer O, Andersen B, Burcharth F, Hovendal C, Pedersen SA, et al. A double‐blinded multicenter trial of somatostatin in the treatment of acute pancreatitis. Surgery, Gynecology & Obstetrics 1992;175(5):397‐400. CENTRAL
Gjørup I, Roikjær O, Andersen B, Burcharth F, Hovendal C, Pedersen SA, et al. Somatostatin in the treatment of acute pancreatitis a double‐blind multicenter trial [abstract]. Digestion 1990;46(3):140. CENTRAL

Goebell 1979 {published data only}

Goebell H, Ammann R, Akovbiantz A. Calcitonin in the treatment of acute pancreatitis. A multi centre double blind study. Irish Journal of Medical Science 1977;146(Suppl 1):105. CENTRAL
Goebell H, Ammann R, Herfarth C. A double‐blind trial of synthetic salmon calcitonin in the treatment of acute pancreatitis. Scandinavian Journal of Gastroenterology 1979;14(7):881‐9. CENTRAL

Goebell 1988 {published data only}

Goebell H. Multicenter double‐blind trial of low‐dose intravenous proteinase‐inhibitor (foy‐r) in patients with acute‐pancreatitis. Zeitschrift Für Gastroenterologie 1988;26(9):447. CENTRAL
Goebell H. Multicenter double‐blind‐study of gabexate‐mesilate (foy), given intravenously in low‐dose in acute‐pancreatitis. Digestion 1988;40(2):83‐. CENTRAL

Grupo Español 1996 {published data only}

Grupo Español Cooperativo para el Estudio de la Somatostatina en el Tratamiento de la Pancreatitis Aguda Grave. [Somatostatina en el tratamiento de la pancreatitis aguda grave: ensayo clínico multicentrico, controlado, con asignación aleatoria y doble ciego. Presentación de resultados en el análisis secuencial]. Revista Española de Enfermedades Digestivas 1996;88(10):717‐8. CENTRAL

Guo 2015 {published data only}

Guo H, Chen J, Suo D. Clinical efficacy and safety of ulinastatin plus octreotide for patients with severe acute pancreatitis. Zhonghua Yixue Zazhi [Chinese Medical Journal] 2015;95(19):1471‐4. [PUBMED: 26178495]CENTRAL

Hansky 1969 {published data only}

Hansky J. The use of a peptidase inhibitor in the treatment of acute pancreatitis. Medical Journal of Australia 1969;1(25):1284‐5. CENTRAL

Hejtmankova 2003 {published data only}

Hejtmankova S, Cech P, Hoskovec D, Kostka R, Leffler J, Kasalicky M, et al. Antibiotic prophylaxis in severe acute pancreatitis: randomized multicenter prospective study with meropenem. Gastroenterology 2003;124(4):A85‐A. CENTRAL

Imrie 1978 {published data only}

Imrie CW, Benjamin IS, Ferguson JC. A single centre double blind trial of trasylol therapy in primary acute pancreatitis. Irish Journal of Medical Science 1977;146(suppl.1):no.103. CENTRAL
Imrie CW, Benjamin IS, Ferguson JC. A single‐centre double‐blind trial of trasylol therapy in primary acute pancreatitis. British Journal of Surgery 1978;65(5):337‐41. CENTRAL
Imrie CW, Benjamin IS, Ferguson JC. Single centre double‐blind trial of trasylol therapy in primary acute pancreatitis. Gut 1977;18(11):A957‐A8. CENTRAL
Imrie CW, Benjamin IS, Ferguson JC, McKay AJ, Mackenzie I, Oneill J, et al. Single center double‐blind trial of trasylol therapy in primary acute‐pancreatitis. Gastroenterologie Clinique et Biologique 1978;2(11):954. CENTRAL
Imrie CW, Benjamin IS, Ferguson JC, Thomson WO, McKay AJ, Blumgart LH. Single‐center double‐blind trial of aprotinin (trasylol) therapy in primary acute‐pancreatitis. Annals of the Royal College of Surgeons of England 1978;60(2):142. CENTRAL

Imrie 1980 {published data only}

Imrie CW, McKay AJ, Neill JO, Campbell FC, Gordon DA, Lang JA. Short duration megadosage iv trasylol in primary acute pancreatitis ‐ a double‐blind trial [abstract]. Gut 1980;21(Suppl 21):A457. CENTRAL

Isenmann 2004 {published data only}

Beger HG, Isenmann R. Discussion on prophylactic antibiotic treatment in patients with predicted severe pancreatitis: a placebo‐controlled, double‐blind trial ‐ reply. Gastroenterology 2004;127(3):1016‐7. CENTRAL
Isenmann R, Ruenzi M, Kron M, Goebell H, Beger HG. Prophylactic antibiotics in severe acute pancreatitis. Results of a double‐blind, placebo‐controlled multicenter trial. Gastroenterology 2003;124(4):A32‐A. CENTRAL
Isenmann R, Runzi M, Kron M, Kahl S, Kraus D, Jung N. Prophylactic antibiotic treatment in patients with predicted severe acute pancreatitis: a placebo‐controlled, double‐blind trial. Gastroenterology 2004;126(4):997‐1004. [see comment]. CENTRAL

Johnson 2001 {published data only}

Johnson CD, Kingsnorth AN, Imrie CW, McMahon MJ, Neoptolemos JP, McKay C, et al. Double blind, randomised, placebo controlled study of a platelet activating factor antagonist, lexipafant, in the treatment and prevention of organ failure in predicted severe acute pancreatitis. Gut 2001;48(1):62‐9. CENTRAL
Kingsnorth AN. Early treatment with lexipafant, a platelet activating factor antagonist reduces mortality in acute pancreatitis: a double blind, randomized, placebo controlled study. Gastroenterology 1997;112(4):A453‐A. CENTRAL
Toh SKC. Lexipafant, a platelet activation factor (paf) antagonist, reduces mortality in a randomised placebo‐controlled study in patients with severe acute pancreatitis [abstract]. Gut 1997;40(Suppl 1):A12. CENTRAL

Kalima 1980 {published data only}

Kalima TV, Lempinen M. The effect of zinc‐protamine‐glucagon in acute pancreatitis. Annales Chirurgiae et Gynaecologiae 1980;69(6):293‐5. CENTRAL

Kingsnorth 1995 {published data only}

Galloway SW, Formela L, Kingsnorth AN. A double blind placebo controlled study of bb‐882 (a potent paf antogonist) in human acute pancreatitis. Gut 1994;35(Suppl 5):T139. CENTRAL
Galloway SW, Formela L, Kingsnorth AN. A double‐blind placebo controlled study of lexipafant (a potent paf antagonist) in acute pancreatitis. Gut 1995;36(3):A478. CENTRAL
Kingsnorth AN, Galloway SW, Formela LJ. Randomized, double‐blind phase ii trial of lexipafant, a platelet‐activating factor antagonist, in human acute pancreatitis. British Journal of Surgery 1995;82(10):1414‐20. CENTRAL

Kirsch 1978 {published data only}

Kirsch A, Werner U, Heinze D. Proteinase inhibiting agents and glucagon in acute pancreatitis (author's transl). Zentralblatt für Chirurgie 1978;103(5):291‐303. CENTRAL

Kronborg 1980 {published data only}

Kronborg O, Bulow S, Joergensen PM, Svendsen LB. A randomized double‐blind trial of glucagon in treatment of first attack of severe acute pancreatitis without associated biliary disease. American Journal of Gastroenterology 1980;73(5):423‐5. CENTRAL
Kronborg O, Jorgensen PM, Bulow S. Controlled randomized trial of glucagon in treatment of 1st attack of severe acute‐pancreatitis without associated biliary disease, interim‐report. Scandinavian Journal of Gastroenterology 1976;11:13. CENTRAL

Llukacaj 2012 {published data only}

Llukacaj A, Naco M, Mandi A, Rakipi B, Kodra N. Prophylactic antibiotic treatment for severe acute necrotizing pancreatitis. European Journal of Anaesthesiology 2012;29(Suppl 50):28. CENTRAL

Luengo 1994 {published data only}

Luengo L, Gómez R, Castellote M, Ros S, Feliu F, Vadillo J. Influence of somatostatin in the evolution of acute pancreatitis. Cirugía Española 1994;56(Suppl 1):11‐2. CENTRAL
Luengo L, Vicente V, Gris F, Coronas JM, Escuder J, Gomez JR, et al. Influence of somatostatin in the evolution of acute pancreatitis: a prospective randomized study. International Journal of Pancreatology 1994;15(2):139‐44. CENTRAL

Luiten 1995 {published data only}

Luiten EJ, Hop WC, Lange JF, Bruining HA. Controlled clinical trial of selective decontamination for the treatment of severe acute pancreatitis. Annals of Surgery 1995;222(1):57‐65. CENTRAL

Marek 1999 {published data only}

Marek TA, Dziurkowska‐Marek A, Nowak A, Kacperek‐Hartleb T, Sierka E, Nowakowska‐Dulawa E. Prospective, randomized, placebo‐controlled trial of ascorbic acid in human acute pancreatitis. Gut 1999;45(Suppl. V):A315. CENTRAL

Martinez 1984 {published data only}

Martinez E, Navarrete F. A controlled trial of synthetic salmon calcitonin in the treatment of severe acute pancreatitis. World Journal of Surgery 1984;8(3):354‐9. CENTRAL

McKay 1997a {published data only}

McKay C, Baxter J, Imrie C. A randomized, controlled trial of octreotide in the management of patients with acute pancreatitis. International Journal of Pancreatology 1997;21(1):13‐9. CENTRAL
McKay C, Baxter JN, Imrie CW. Octreotide in acute‐pancreatitis ‐ a randomized controlled trial. British Journal of Surgery 1994;81(12):1814‐. CENTRAL

McKay 1997b {published data only}

Curran FJM, Sharples CE, Young CA, Curtis L, McKay CJ, Baxter JN, et al. Controlled trial of lexipafant in severe acute pancreatitis. Pancreas 1995;11(4):424. CENTRAL
McKay CJ, Curran F, Sharples C, Baxter JN, Imrie CW. Prospective placebo‐controlled randomized trial of lexipafant in predicted severe acute pancreatitis. British Journal of Surgery 1997;84(9):1239‐43. CENTRAL
McKay CJ, Imrie CW. Prospective placebo‐controlled randomized trial of lexipafant in predicted severe acute pancreatitis ‐ reply. British Journal of Surgery 1998;85(2):280. CENTRAL

Moreau 1986 {published data only}

Moreau J, Bommelaer G, Buscail L, Benque A, Jacob C, Galleyrand J, et al. Preliminary‐results of a multicentric double‐blind trial of somatostatin (s) vs placebo (p) in acute‐pancreatitis (ap). Digestive Diseases and Sciences 1986;31(10):S24‐S. CENTRAL

MRC Multicentre Trial 1977 {published data only}

Death from acute pancreatitis. M.R.C. Multicentre trial of glucagon and aprotinin. Lancet 1977;2(8039):632‐5. CENTRAL

Nordback 2001 {published data only}

Nordback I, Sand J, Saaristo R, Paajanen H. Early treatment with antibiotics reduces the need for surgery in acute necrotizing pancreatitis‐‐a single‐center randomized study. Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract 2001;5(2):113‐8. CENTRAL

Ohair 1993 {published data only}

Ohair DP, Hoffman RG, Schroeder H, Wilson SD. Octreotide in the treatment of acute‐pancreatitis ‐ a prospective, randomized trial. Gastroenterology 1993;104(4):A326‐A. CENTRAL

Olah 2007 {published data only}

Olah A, Belagyi T, Poto L, Romics Jr L, Bengmark S. Synbiotic control of inflammation and infection in severe acute pancreatitis: a prospective, randomized, double blind study. Hepato‐Gastroenterology 2007;54(74):590‐4. CENTRAL

Paran 1995 {published data only}

Paran H, Neufeld D, Mayo A, Shwartz I, Singer P, Kaplan O, et al. Preliminary report of a prospective randomized study of octreotide in the treatment of severe acute pancreatitis. Journal of the American College of Surgeons 1995;181(2):121‐4. CENTRAL

Pederzoli 1993a {published data only}

Bassi C, Cavallini G, Bovo P, Bonora A, Vesentini S, Pederzoli P. Gabexate mesilate in acute pancreatitis (ap). The Italian multicentric trial. International Journal of Pancreatology 1992;12(1):76. CENTRAL
Bassi C, Vesentini S, Campedelli A, Nifosi F, Girelli R, Falconi M, et al. Imipenem prophylaxis in necrotizing pancreatitis: results of a multicenter study. International Journal of Pancreatology 1992;12(1):77. CENTRAL
Pederzoli P, Bassi C, Vesentini S, Campedelli A. A randomized multicenter clinical trial of antibiotic prophylaxis of septic complications in acute necrotizing pancreatitis with imipenem. Surgery, Gynecology & Obstetrics 1993;176(5):480‐3. CENTRAL

Pederzoli 1993b {published data only}

Bassi C, Cavallini G, Bovo P, Bonora A, Vesentini S, Pederzoli P. Gabexate mesilate in acute pancreatitis (ap). The Italian multicentric trial. International Journal of Pancreatology 1992;12(1):76. CENTRAL
Bassi C, DiCarlo V, Zerbi A, Galloro V, Uomo G, Fontana G, et al. Role of imipenem (i) in preventing infected necrosis (in) during acute pancreatitis (np) results of the Italian multicenter study [abstract]. Digestion 1992;52(2):68. CENTRAL
Pederzoli P, Cavallini G, Falconi M, Bassi C. Gabexate mesilate vs aprotinin in human acute pancreatitis (ga.Me.P.A.): A prospective, randomized, double‐blind multicenter study. International Journal of Pancreatology 1993;14(2):117‐24. CENTRAL

Perezdeoteyza 1980 {published data only}

Perezdeoteyza C, Rebollar JL, Ballarin M, Chantres MT, Alonso A, Marin J, et al. Controlled treatment of acute‐pancreatitis ‐ double‐blind‐study with cimetidine [Tratamiento controlado de la pancreatitis aguda. Ensayo doble ciego con cimetidina]. Revista Clinica Española 1980;158(6):263‐6. CENTRAL

Pettila 2010 {published data only}

Kyhala L, Lindstrom O, Kylanpaa L, Mustonen H, Puolakkainen P, Kemppainen E, et al. Activated protein C retards recovery from coagulopathy in severe acute pancreatitis. Scandinavian Journal of Clinical and Laboratory Investigation 2016;76(1):10‐6. CENTRAL
Pettila V, Kyhala L, Kylanpaa ML, Leppaniemi A, Tallgren M, Markkola A, et al. APCAP ‐ activated protein C in acute pancreatitis: a double‐blind randomized human pilot trial. Critical Care 2010;14(4):R139. CENTRAL

Plaudis 2010 {published data only}

Plaudis H, Boka V, Pupelis G. Early low volume oral synbiotic/prebiotic supplemented enteral stimulation of the gut in patients with sap: randomized double blind prospective study. HPB 2010;12(Suppl 1):49. CENTRAL

Poropat 2015 {published data only}

Poropat G, Giljaca V, Licul V, Hauser G, Milic S, Stimac D. Imipenem prophylaxis for predicted severe acute pancreatitis‐preliminary results of a randomized clinical trial. United European Gastroenterology Journal 2015;3(5 Suppl):A172. CENTRAL

Rokke 2007 {published data only}

Rokke O, Harbitz TB, Liljedal J, Pettersen T, Fetvedt T, Heen LO, et al. Early treatment of severe pancreatitis with imipenem: a prospective randomized clinical trial. Scandinavian Journal of Gastroenterology 2007;42(6):771‐6. CENTRAL

Sainio 1995 {published data only}

Sainio V, Kemppainen E, Puolakkainen P, Taavitsainen M, Kivisaari L, Valtonen V, et al. Early antibiotic treatment in acute necrotising pancreatitis. Lancet 1995;346(8976):663‐7. CENTRAL
Sainio V, Kemppainen E, Puolakkainen P, Taavitsainen M, Kivisaari L, Valtonen V, et al. Early antibiotic‐treatment in acute necrotizing pancreatitis ‐ a prospective randomized study. Gastroenterology 1994;106(4):A319‐A. CENTRAL
Sainio V, Kemppainen E, Puolakkainen P, Taavitsainen M, Kivisaari L, Valtonen V, et al. Prophylactic antibiotic‐treatment in acute necrotizing pancreatitis ‐ a prospective randomized study. Gastroenterology 1993;104(4):A332‐A. CENTRAL

Sateesh 2009 {published data only}

Sateesh J, Bhardwaj P, Singh N, Saraya A. Effect of antioxidant therapy on hospital stay and complications in patients with early acute pancreatitis: a randomised controlled trial. Tropical Gastroenterology 2009;30(4):201‐6. CENTRAL

Sharma 2011 {published data only}

Sharma B, Srivastava S, Singh N, Sachdev V, Kapur S, Saraya A. Role of probiotics on gut permeability and endotoxemia in patients with acute pancreatitis: a double‐blind randomized controlled trial. Journal of Clinical Gastroenterology 2011;45(5):442‐8. CENTRAL

Sillero 1981 {published data only}

Sillero C, Perez‐Mateo M, Vazquez N, Martin A. Controlled trial of cimetidine in acute pancreatitis. European Journal of Clinical Pharmacology 1981;21(1):17‐21. CENTRAL

Siriwardena 2007 {published data only}

Sinwardena AK, Mason JM, Balachandra S, Bagul A, Galloway S, Formela L, et al. Randomized, double‐blind, placebo‐controlled, trial of high‐dose intravenous anti‐oxidant therapy in severe acute pancreatitis. Gastroenterology 2006;130(4):A83‐A. CENTRAL
Siriwardena AK, Mason JM, Balachandra S, Bagul A, Galloway S, Formela L, et al. Randomised, double blind, placebo controlled trial of intravenous antioxidant (n‐acetylcysteine, selenium, vitamin c) therapy in severe acute pancreatitis. Gut 2007;56(10):1439‐44. CENTRAL

Spicak 2002 {published data only}

Hubaczova M, Spicak J, Antos F, Bartova I, Cech P, Kasalicky P, et al. The role of antibiotic treatment in severe form of acute pancreatitis: a randomized prospective study. Gastroenterology 2001;120(5):A645‐A. CENTRAL
Hubaczová M, Spicák J, Antós F, Bártová I, Cech P, Kasalický M, et al. The role of antibiotic treatment in severe form of acute pancreatitis: a randomized prospective study [abstract]. Gut 2000;47(Suppl III):A142. CENTRAL
Spicak J, Hubaczova M, Antos F, Bartova J, Cech P, Kasalicky M, et al. Antibiotics in the treatment of acute pancreatitis ‐ findings from a randomized multi‐centre prospective study [Antibiotika v léčbĕ akutní pankreatitidy ‐ poučení z randomizonvané multicentrické prospektivni studie]. Ceska a Slovenska Gastroenterologie a Hepatologie 2002;56(5):183‐9. CENTRAL

Spicak 2003 {published data only}

Spicak J, Hejtmankova S, Hubaczova M, Antos F, Bartova J, Cech P, et al. Antibiotic prophylaxis of infectious complications of acute pancreatitis ‐ the results of randomised study by meropenem [Antibiotiká profylaxe infekĉních komplikací u akutní pankreatitidy ‐ výsledky randomizonvané studie s meropenemem]. Ceska a Slovenska Gastroenterologie a Hepatologie 2003;57(6):222‐7. CENTRAL

Storck 1968 {published data only}

Storck G, Persson B. Trasylol treatment of acute pancreatitis. A double‐blind study [Trasylol vid akut pankreatit. En dubbel‐blindstudie]. Nordisk Medicin 1968;79(20):651‐3. CENTRAL

Trapnell 1974 {published data only}

Trapnell JE. Controlled study of aprotinin in the treatment of acute pancreatitis [Etude controlee de l'aprotinine dans le traitement de la pancreatie aigue]. Annales de Chirurgie 1976;30(3):201. CENTRAL
Trapnell JE, Rigby CC, Talbot CH, Duncan EH. A controlled trial of trasylol in the treatment of acute pancreatitis. British Journal of Surgery 1974;61(3):177‐82. CENTRAL
Trapnell JE, Rigby CC, Talbot CH, Duncan EH. Controlled study on trasylol in the treatment of acute pancreatitis [Eine kontrollierte prufung von trasylol bie der behandlung der akuten pankreatitis]. Die Medizinische Welt 1974;25(50):2106‐11. CENTRAL
Trapnell JE, Talbot CH, Capper WM. Trasylol in acute pancreatitis. The American Journal of Digestive Diseases 1967;12(4):409‐12. CENTRAL

Tykka 1985 {published data only}

Tykka HT, Vaittinen EJ, Mahlberg KL. A randomized double‐blind study using cana2edta, a phospholipase a2 inhibitor, in the management of human acute pancreatitis. Scandinavian Journal of Gastroenterology 1985;20(1):5‐12. CENTRAL

Uhl 1999 {published data only}

Uhl W, Buchler MW, Malfertheiner P, Beger HG, Adler G, Gaus W. A randomised, double blind, multicentre trial of octreotide in moderate to severe acute pancreatitis. Gut 1999;45(1):97‐104. CENTRAL
Uhl W, Malfertheiner P, Adler G, Bruch HP, Lankisch PG, Lorenz D, et al. A randomized controlled multicentric trial on the role of octreotide in human acute pancreatitis. Gastroenterology 1997;112(4):A488‐A. CENTRAL

Usadel 1985 {published data only}

Usadel KH, Uberla KK, Leuschner U. Treatment of acute‐pancreatitis with somatostatin ‐ results of the multicenter double‐blind trial (apts‐study). Digestive Diseases and Sciences 1985;30(10):992. CENTRAL

Valderrama 1992 {published data only}

Valderrama R, Pérez‐Mateo M, Navarro S, Vázquez N, Sanjosé L, Adrián MJ, et al. Multicenter double‐blind trial of gabexate mesylate (foy) in unselected patients with acute pancreatitis. Digestion 1992;51(2):65‐70. CENTRAL

Vege 2015 {published data only}

Vege SS, Atwal T, Bi Y, Chari ST, Clemens MA, Enders FT. Pentoxifylline treatment in severe acute pancreatitis: a pilot, double‐blind, placebo‐controlled, randomized trial. Gastroenterology 2015;149(2):318‐20.e3. CENTRAL
Vege SS, Atwal T, Chari ST, Pearson RK, Loftus CG, Enders F, et al. Pentoxifylline treatment in predicted severe acute pancreatitis: a randomized double‐blind placebo‐controlled trial. Gastroenterology 2013;144(Suppl 1):S111‐2. CENTRAL

Wang 2011 {published data only}

Wang X, Li W, Niu C, Pan L, Li N, Li J. Thymosin alpha 1 is associated with improved cellular immunity and reduced infection rate in severe acute pancreatitis patients in a double‐blind randomized control study. Inflammation 2011;34(3):198‐202. CENTRAL

Wang 2013a {published data only}

Wang G, Wen J, Wilbur RR, Wen P, Zhou SF, Xiao X. The effect of somatostatin, ulinastatin and salvia miltiorrhiza on severe acute pancreatitis treatment. American Journal of the Medical Sciences 2013;346(5):371‐6. CENTRAL

Wang 2013b {published data only}

Wang R, Yang F, Guo Z, Yi Z, Huang L, Hu B, et al. Alleviation of acute pancreatitis with octreotide and celecoxib‐a randomized controlled trial. Journal of Gastroenterology and Hepatology 2013;28(Suppl):16‐7. CENTRAL
Wang R, Yang F, Guo Z, Yi Z, Huang L, Tang C. Alleviation of acute pancreatitis with octreotide and celecoxib: a prospective randomized controlled trial. Gastroenterology 2013;144(Suppl 1):S139. CENTRAL
Wang R, Yang F, Guo ZZ, Yi ZH, Huang LB, Hu B, et al. Alleviation of acute pancreatitis with octreotide and celecoxib: a prospective randomized controlled trial. Journal of Digestive Diseases 2014;15(Suppl 1):8. CENTRAL

Wang 2013c {published data only}

Wang R, Yang F, Wu H, Wang Y, Huang Z, Hu B, et al. High‐dose versus low‐dose octreotide in the treatment of acute pancreatitis: a randomized controlled trial. Peptides 2013;40:57‐64. [DOI: 10.1016/j.peptides.2012.12.018]CENTRAL
Wang R, Yang F, Wu H, Wang YF, Hu B, Zhang MG, et al. Octreotide at high dose in the treatment of acute pancreatitis: a prospective randomized controlled trial. Gastroenterology 2012;142(5):S62. CENTRAL

Wang 2016 {published data only}

Wang G, Liu Y, Zhou SF, Qiu P, Xu L, Wen P, et al. Effect of somatostatin, ulinastatin and gabexate on the treatment of severe acute pancreatitis. American Journal of the Medical Sciences 2016;351(5):506‐12. CENTRAL

Xia 2014 {published data only}

Xia YX, Liu XZ, Zhang XD, Shang PJ, Guo J. Efficacy and safety of omeprazole combined with somatostatin in treatment of severe acute pancreatitis. Shijie Huaren Xiaohua Zazhi [World Chinese Journal of Digestology] 2014;22(8):1179‐83. CENTRAL

Xue 2009 {published data only}

Xue P, Deng LH, Zhang ZD, Yang XN, Wan MH, Song B, et al. Effect of antibiotic prophylaxis on acute necrotizing pancreatitis: Results of a randomized controlled trial. Journal of Gastroenterology and Hepatology (Australia) 2009;24(5):736‐42. CENTRAL

Yang 1999 {published data only}

Yang JQ, Wang P, Zhong J, Liu YK, Liu ZJ. A controlled study of somatostatin in the treatment of acute pancreatitis. Journal of Jinan University 1999;20(2):50‐2. CENTRAL

Yang 2012 {published data only}

Yang F, Wu H, Li Y, Li Z, Wang C, Yang J, et al. Prevention of severe acute pancreatitis with octreotide in obese patients: a prospective multi‐center randomized controlled trial. Pancreas 2012;41(8):1206‐12. CENTRAL

Zhu 2014 {published data only}

Zhu YM, Lin S, Dang XW, Wang M, Li L, Sun RQ, et al. Effects of probiotics in treatment of severe acute pancreatitis. Shijie Huaren Xiaohua Zazhi [World Chinese Journal of Digestology] 2014;22(32):5013‐7. CENTRAL

Akzhigitov 1968 {published data only}

Akzhigitov GN. Use of monoaminoxidase inhibitor vetrazine in the treatment of acute pancreatitis [Primenenie ingibitora monoaminoksidazy vetrazina pri lechenii ostrogo pankreatita]. Terapevticheskii Arkhiv 1968;40(10):82‐4. CENTRAL

Akzhigitov 1969 {published data only}

Akzhigitov GN, Grach Z, Rubtsova LK, Koroleva VG, Pozdniakova VP. Use of glycocycline in the treatment of patients with acute pancreatitis and cholepancreatitis. Antibiotiki 1969;14(2):174‐8. CENTRAL

Al‐Leswas 2013a {published data only}

Al‐Leswas D, Arshad A, Eltweri A, Chung WY, Al‐Taan O, Pollard C, et al. An omega‐3 rich lipid emulsion is associated with improved clinical outcome in patients with severe acute pancreatitis: a randomised double‐blind controlled trial. British Journal of Surgery 2013;100(Suppl 4):2. CENTRAL

Al‐Leswas 2013b {published data only}

Al‐Leswas D, Chung WY, Eltweri A, Arshad A, Al‐Taan O, Pollard C, et al. Evaluation of the acute inflammatory response to omega‐3 fatty acids in patients with severe acute pancreatitis: a randomised controlled trial. Pancreatology 2013;13(1):e6. CENTRAL

Al‐Leswas 2013c {published data only}

Al‐Leswas D, Chung WY, Eltweri A, Stephenson J, Arshad A, Pollard C, et al. Evaluation of the cytokines response to omega‐3 fatty acids in patients with severe acute pancreatitis: a randomised controlled trial. Clinical Nutrition 2013;32(Suppl 1):S2. CENTRAL

Al‐Leswas 2013d {published data only}

Al‐Leswas D, Eltweri A, Arshad A, Chung WY, Al‐Taan O, Pollard C, et al. Progression of the early warning scores (ews) in severe acute pancreatitis patients treated with omega‐3 fish oil: a randomised control trial. Clinical Nutrition 2013;32(Suppl 1):S47‐S8. CENTRAL

Al‐Leswas 2013e {published data only}

Al‐Leswas D, Eltweri A, Arshad A, Chung WY, Stephenson J, Pollard C, et al. An omega‐3 rich lipid emulsion is associated with fewer new organ failures, less systemic inflammatory response syndrome and improves the outcome in patients with severe acute pancreatitis: a randomised double‐blind, phase ii control trial. Pancreatology 2013;13(1):e2. CENTRAL

Al‐Leswas 2013f {published data only}

Al‐Leswas D, Eltweri A, Chung WY, Al‐Taan O, Arshad A, Pollard C, et al. An omega‐3 rich lipid emulsion is associated with fewer new organ failures, less systemic inflammatory response syndrome and improves the outcome in patients with severe acute pancreatitis: A randomised double‐blind, phase ii control trial. Clinical Nutrition 2013;32(Suppl 1):S2‐3. CENTRAL

Al‐Leswas 2013g {published data only}

Al‐Leswas D, Eltweri A, Hall T, Stephenson J, Pollard C, Garcea G, et al. Safety and tolerability of two parenteral lipid emulsions in patients with severe acute pancreatitis as measured by serum triglyceride and cholesterol levels: a randomised controlled trial. Clinical Nutrition 2013;32(Suppl 1):S49‐50. CENTRAL

Amundsen 1972 {published data only}

Amundsen E. The use of protease inhibitors during acute haemorrhagic pancreatitis. Experimental findings and clinical implications. Annales Chirurgiae et Gynaecologiae Fenniae 1972;61(5):284‐7. CENTRAL

Andersson 2008 {published data only}

Andersson RG. Probiotics in acute pancreatitis. British Journal of Surgery 2008;95(8):941‐2. CENTRAL

Baden 1967 {published data only}

Baden H, Jordal K, Lund F, Zachariae F. A double‐blind controlled clinical trial of trasylol. Preliminary results in acute pancreatitis and in prophylaxis against postoperative pancreatitis. Acta Chirurgica Scandinavica 1967;378(Suppl):97‐102. CENTRAL

Baden 1969 {published data only}

Baden H, Jordal K, Lund F, Zachariae F. Prophylactic and curative action of trasylol in pancreatitis; a double blind trial. Scandinavian Journal of Gastroenterology 1969;4(3):291‐5. CENTRAL

Bai 2013 {published data only}

Bai YT, Guo XZ, Li HY, Shao XD, Cui ZM, Wang D, et al. Therapeutic effect of ulinastatin vs gabexate mesilate in management of acute pancreatitis. Shijie Huaren Xiaohua Zazhi [World Chinese Journal of Digestology] 2013;21(14):1339‐42. CENTRAL

Bassi 1998 {published data only}

Bassi C, Falconi M, Talamini G, Uomo G, Papaccio G, Dervenis C, et al. Controlled clinical trial of pefloxacin versus imipenem in severe acute pancreatitis. Gastroenterology 1998;115(6):1513‐7. CENTRAL

Beechey‐Newman 1991 {published data only}

Beechey‐Newman N, Lee W, Wilkinson M, Grogono J, McPherson GAD. Treatment with high dose octreotide improves the clinical course of acute pancreatitis [abstract]. Gut 1991;32(Suppl.5):A558. CENTRAL

Beechey‐Newman 1993 {published data only}

Beechey‐Newman N. Controlled trial of high‐dose octreotide in treatment of acute pancreatitis. Evidence of improvement in disease severity. Digestive Diseases and Sciences 1993;38(4):644‐7. CENTRAL

Beger 2001 {published data only}

Beger HG. Early treatment with antibiotics reduces the need for surgery in acute necrotizing pancreatitis ‐ a single‐center randomized study ‐ commentary. Journal of Gastrointestinal Surgery 2001;5(2):119‐20. CENTRAL

Bender 1992 {published data only}

Bender HJ, Albrecht MD, Quintel M, Ackern K. Use of octreotidacetate (sandostatin) in the treatment of necrotising haemorrhagic pancreatitis. Der Anaesthesist 1992;41(Suppl 2):S130. CENTRAL

Binder 1993 {published data only}

Binder M, Buchler M, Uhl W, Friess H, Dennler HJ, Beger HG. Octreotide in the treatment of acute pancreatitis: results of an unicentric prospective trial with three different octreotide dosages [Octreotide bei akuter pankreatitis: Ergebnisse einer unizentrischen prospektiven studie mit drei verschiedenen octreotide‐dosierungen]. Langenbecks Archiv fur Chirurgie 1993;Suppl 1 Forumband:233‐8. CENTRAL

Binder 1994 {published data only}

Binder M, Uhl W, Friess H, Malfertheiner P, Buchler MW. Octreotide in the treatment of acute pancreatitis: results of a unicenter prospective trial with three different octreotide dosages. Digestion 1994;55(Suppl 1):20‐3. CENTRAL

Brown 2004 {published data only}

Brown A. Prophylactic antibiotic use in severe acute pancreatitis: Hemlock, help, or hype?. Gastroenterology 2004;126(4):1195‐8. CENTRAL

Buchler 1988 {published data only}

Buchler M, Malfertheiner P, Uhl W, Wolf HR, Schwab G, Beger HG. Gabexate mesilate in the therapy of acute pancreatitis. Multicenter study of tolerance of a high intravenous dose (4 g/day) [Gabexat‐mesilat in der therapie der akuten pankreatitis. Multicenterstudie zur vertraglichkeit einer hohen intravenosen dosis (4 g/Tag)]. Medizinische Klinik 1988;83(10):320‐4, 52. CENTRAL

Cameron 1979 {published data only}

Cameron JL, Mehigan D, Zuidema GD. Evaluation of atropine in acute pancreatitis. Surgery Gynecology and Obstetrics 1979;148(2):206‐8. CENTRAL

Cheng 2008 {published data only}

Cheng YX, Wang M, Cheng X. Effect of dachaihu decoction in treating acute mild pancreatitis of gan‐qi stagnant type. Zhongguo Zhongxiyi Jiehe Zqzhi [Chinese Journal of Integrated Traditional and Western Medicine] 2008;28(9):793‐6. CENTRAL

Cullimore 2008 {published data only}

Cullimore J, Cotter L, Gonzalez A. Antibiotics in acute necrotising pancreatitis [author reply]. Lancet 2008;371(9618):1072. CENTRAL

Curtis 1997 {published data only}

Curtis LD. Lexipafant(bb‐882), a potent PAF antagonist in acute pancreatitis. Advances in Experimental Medicine and Biology 1997;416:361‐3. CENTRAL

D'Amico 1990 {published data only}

D'Amico D, Favia G, Biasiato R, Casaccia M, Falcone F, Fersini M, et al. The use of somatostatin in acute pancreatitis‐‐results of a multicenter trial. Hepato‐Gastroenterology 1990;37(1):92‐8. CENTRAL

Da Silvereira 2002 {published data only}

Da Silveira EBV, Barkin JS. Antibiotic prophylaxis in acute necrotizing pancreatitis. American Journal of Gastroenterology 2002;97(6):1557‐9. CENTRAL

De Vries 2007 {published data only}

De Vries AC, Besselink MG, Buskens E, Ridwan BU, Schipper M, van Erpecum KJ, et al. Randomized controlled trials of antibiotic prophylaxis in severe acute pancreatitis: relationship between methodological quality and outcome. Pancreatology 2007;7(5‐6):531‐8. CENTRAL

Dikkenberg 2008 {published data only}

Dikkenberg GM. Probiotic prophylaxis in patients with predicted severe acute pancreatitis: a randomised, double‐blind, placebo‐controlled trial and informed consent procedure [author reply ‐ 4] [Probioticaprofylaxe bij voorspeld ernstige acute pancreatitis; gerandomiseerde, dubbelblinde, placebogecontroleerde trial en informed‐consentprocedure]. Nederlands Tijdschrift voor Geneeskunde 2008;152(28):1592. CENTRAL

Dreiling 1977 {published data only}

Dreiling DA, Nacchiero M, Kaplan. I. Is there a place for steroids in the treatment of pancreatic inflammation?. American Journal of Gastroenterology 1977;67(1):21‐8. CENTRAL

Du 2002 {published data only}

Du W, Shen D, Huang C, Zhou Y. Effect of high‐dose vitamin C on cellular immunity of patients with acute pancreatitis. Wei Chang Bing Xue [Chinese Journal of Gastroenterology] 2002;7(4):213‐5. CENTRAL

Du 2003 {published data only}

Du WD, Yuan ZR, Sun J, Tang JX, Cheng AQ, Shen DM, et al. Therapeutic efficacy of high‐dose vitamin c on acute pancreatitis and its potential mechanisms. World Journal of Gastroenterology 2003;9(11):2565‐9. CENTRAL

Dürr 1985 {published data only}

Dürr GH, Schaefers A, Maroske D, Bode JC. A controlled study on the use of intravenous fat in patients suffering from acute attacks of pancreatitis. Infusionstherapie und Klinische Ernahrung 1985;12(3):128‐33. CENTRAL

Freise 1985 {published data only}

Freise J, Schmidt FW, Maferstedt P, Schmid K. Gabexate mesilate and camostate: New inhibitors of phospholipase a2 and their influence on the alpha‐amylase activity in serum of patients with acute pancreatitis. Clinical Biochemistry 1985;18(4):224‐9. CENTRAL

Friess 1994 {published data only}

Friess H, Hofbauer B, Buchler MW. The role of somatostatin and octreotide in pancreatic surgery and in acute and chronic pancreatitis. Digestive Surgery 1994;11(3‐6):445‐50. CENTRAL

Gabryelewicz 1968 {published data only}

Gabryelewicz A, Niewiarowski S. Activation of blood clotting and inhibition of fibrinolysis in acute pancreatitis. Thrombosis et Diathesis Haemorrhagica 1968;20(3):409‐14. CENTRAL

Gabryelewicz 1976 {published data only}

Gabryelewicz A, Olszewski S, Szalaj W, Puchalski Z, Stasiewicz J. Heparin and glucagon treatment of acute pancreatitis‐‐results (author's transl) [Wyniki leczenia ostrego zapalenia trzustki za pomoca heparyny lub glukagonu]. Przeglad Lekarski 1976;33(2):323‐8. CENTRAL

Gao 2015b {published data only}

Gao Q, Liang N. Integrated traditional Chinese medicine improves acute pancreatitis via the downregulation of prss1 and spink1. Experimental and Therapeutic Medicine 2015;9(3):947‐54. CENTRAL

Garcia 2005 {published data only}

Garcia DA, Gonzalez JA, Rodriguez N, Britton CS, Hinojo E, Quintanilla C, et al. Utility of synbiotic therapy in acute pancreatitis. A double blind randomized clinical trial. Gastroenterology 2005;128(4 Suppl 2):A173‐A. CENTRAL

Gostishchev 1977 {published data only}

Gostishchev VK, Lutsevich EV, Tolstykh PI, Vladimirov VG, Sergienko VI. [effectiveness of proteolysis inhibitors in treatment of acute pancreatitis]. Khirurgiia 1977, (7):87‐92. CENTRAL

Guo 2013 {published data only}

Guo Z, Wang R, Tang C. Effect of octreotide on plasma levels of somatostatin, interleukin‐6, and tumor necrosis factor‐alpha in patients with acute pancreatitis: A prospective single‐center randomized controlled trial. Gastroenterology 2013;144(5 Suppl):S566. CENTRAL

Hajdu 2012 {published data only}

Hajdu N, Belagyi T, Issekutz A, Bartek P, Gartner B, Olah A. Intravenous glutamine and early nasojejunal nutrition in severe acute pancreatitis ‐‐ a prospective randomized clinical study [Intravenas glutamin es korai nasojejunalis taplalas egyuttes alkalmazasa sulyos acut pancreatitisben ‐‐ prospektiv randomizalt kettos vak kontrollalt klinikai vizsgalat]. Magyar sebeszet 2012;65(2):44‐51. CENTRAL

Harinath 2002 {published data only}

Harinath G, O'Riordan B. Prospective randomized double‐blind placebo‐controlled trial of glyceryl trinitrate in endoscopic retrograde cholangiopacreatography‐induced pancreatitis (Br J Surg 2001;88:1178‐82). The British Journal of Surgery 2002;89(5):628‐9; discussion 9. CENTRAL

Hart 2008 {published data only}

Hart PA, Bechtold ML, Marshall JB, Choudhary A, Puli SR, Roy PK. Prophylactic antibiotics in necrotizing pancreatitis: a meta‐analysis. Southern Medical Journal 2008;101(11):1126‐31. CENTRAL

He 2004 {published data only}

He XL, Ma QJ, Lu JG, Chu YK, Du XL. Effect of total parenteral nutrition (tpn) with and without glutamine dipeptide supplementation on outcome in severe acute pancreatitis (sap). Clinical Nutrition, Supplement 2004;1(1):43‐7. CENTRAL

Helton 2001 {published data only}

Helton S, Nordback I, Rattner DW, Gloor B, Kumar A, Sarr MG, et al. Early treatment with antibiotics reduces the need for surgery in acute necrotizing pancreatitis ‐ a single‐center randomized study ‐ discussion. Journal of Gastrointestinal Surgery 2001;5(2):118‐9. CENTRAL

Hoekstra 2008 {published data only}

Hoekstra JH. Probiotic prophylaxis in patients with predicted severe acute pancreatitis: a randomised, double‐blind, placebo‐controlled trial and informed consent procedure [Probioticaprofylaxe bij voorspeld ernstige acute pancreatitis; gerandomiseerde, dubbelblinde, placebogecontroleerde trial en informed‐consentprocedure]. Nederlands Tijdschrift voor Geneeskunde 2008;152(28):1591‐2; author reply 3‐4. CENTRAL

Holub 1974 {published data only}

Holub K, Om P. Treatment of acute pancreatitis using glucagon [Glukagonbehandlung der akuten pankreatitis]. Zentralblatt fur Chirurgie 1974;99(24):748‐50. CENTRAL

Howard 2007 {published data only}

Howard TJ. As good as it gets: the study of prophylactic antibiotics in severe acute pancreatitis. Annals of Surgery 2007;245(5):684‐5. CENTRAL

Howes 1975 {published data only}

Howes R, Zuidema GD, Cameron JL. Evaluation of prophylactic antibiotics in acute pancreatitis. Journal of Surgical Research 1975;18(2):197‐200. CENTRAL

Huang 2008 {published data only}

Huang XX, Wang XP, Ma JJ, Jing DD, Wang PW, Wu K. Effects of enteral nutrition supplemented with glutamine and arginine on gut barrier in patients with severe acute pancreatitis: a prospective randomized controlled trial. National Medical Journal of China 2008;88(34):2407‐9. CENTRAL

Issekutz 2002 {published data only}

Issekutz A, Olah A, Bengmark S. Early enteral supply of lactobacilli + fibre vs. Placebo + fibre in severe acute pancreatitis ‐ a prospective, randomized, controlled trial. Zeitschrift fur Gastroenterologie 2002;40(5):338. CENTRAL

Ivanov 2002 {published data only}

Ivanov Iu V, Chudnykh SM, Mozgalin AG. Effectiveness of mexidol in acute pancreatitis [Effektivnost' meksidola pri ostrom pankreatite]. Klinicheskaia Meditsina 2002;80(9):44‐6. CENTRAL

Jiang 1988 {published data only}

Jiang LS, Fang PS, Xu ZH. Controlled trial of calcium channel blocker, rou gui qing, and ‐receptor blocker for treatment of 80 patients with acute pancreatitis. Linchuang Gandanbing Zazhi [Chinese Journal of Clinical Hepatology] 1988;4(4):48. CENTRAL

Karakan 2007 {published data only}

Karakan T, Ergun M, Dogan I, Cindoruk M, Unal S. Comparison of early enteral nutrition in severe acute pancreatitis with prebiotic fiber supplementation versus standard enteral solution: a prospective randomized double‐blind study. World Journal of Gastroenterology 2007;13(19):2733‐7. CENTRAL

Karakoyunlar 1999 {published data only}

Karakoyunlar O, Sivrel E, Tanir N, Denecli AG. High dose octreotide in the management of acute pancreatitis. Hepato‐Gastroenterology 1999;46(27):1968‐72. CENTRAL

Karavanov 1966 {published data only}

Karavanov AG, Osingolts SL. The use of epsilon‐aminocaproic acid in the treatment of acute pancreatits [Primenenie epsilon‐aminokapronovoi kisloty (E‐AKK) v lechenii ostrykh pankreatitov]. Klinicheskaia Meditsina 1966;44(5):13‐5. CENTRAL

Lasztity 2005a {published data only}

Lasztity N, Hamvas J, Biró L, Németh E, Marosvölgyi T, Decsi T, et al. Effect of enterally administered n‐3 polyunsaturated fatty acids in acute pancreatitis‐‐a prospective randomized clinical trial. Clinical Nutrition 2005;24(2):198‐205. CENTRAL

Lasztity 2005b {published data only}

Lasztity N, Pap A, Hamvas J, Biro L, Nemeth E, Marosvolgyi T, et al. Effect of enterally administered n‐3 polyunsaturated fatty acids in acute pancreatitis ‐ a prospective randomized clinical trial. Gastroenterology 2005;128(4):A174‐A. CENTRAL

Lasztity 2006 {published data only}

Lasztity N, Hamvas J, Biro L, Nemeth E, Marosvolgyi T, Decsi T, et al. Enteral administration of n‐3 polyunsaturated fatty acids in acute pancreatitis [Az n‐3 többszörösen telítetlen zsírsavak enteralis adása akut pancreatitisben ‐ előzetes eredmények]. Lege Artis Medicinae 2006;16(10):848‐54. CENTRAL

Lata 1998 {published data only}

Lata J, Dít P, Julínková K, Precechtělová M, Prásek J. Effect of octreotide on the clinical course of acute pancreatitis and levels of free oxygen radicals and antioxidants [Vliv octreotidu na klinicky prubeh akutni pankreatitidy a hladinu volnych kyslikovych radikala a antioxidacnich latek]. Vnitrní lékarství 1998;44(9):524‐7. CENTRAL

Lata 2010 {published data only}

Lata J, Juránková J, Stibůrek O, Príbramská V, Senkyrík M, Vanásek T. Probiotics in acute pancreatitis‐‐a randomised, placebo‐controlled, double‐blind study [Probiotika u akutni pankreatitidy‐‐randomizovana, placebem kontrolovana, dvojite slepa studie]. Vnitrní lékarství 2010;56(2):111‐4. CENTRAL

Lim 2015 {published data only}

Lim CL, Lee W, Liew YX, Tang SS, Chlebicki MP, Kwa AL. Role of antibiotic prophylaxis in necrotizing pancreatitis: a meta‐analysis. Journal of Gastrointestinal Surgery 2015;19(3):480‐91. CENTRAL

Lu 2006 {published data only}

Lu J, Liu CW, Zheng YK, Hu W, Zhu KY, Hu WH. Effects of glutamine in hemodynamics and oxygen metabolism in patients with severe acute pancreatitis. Zhongguo Linchuang Yingyang Zazhi [Chinese Journal of Clinical Nutrition] 2006;14(4):227‐30. CENTRAL

Lu 2008 {published data only}

Lu HG, Shi YB, Zhao LM, Bai C, Wang X. Role of enteral ebselen and ethylhydroxyethyl cellulose in pancreatitis‐associated multiple‐organ dysfunction in humans. Journal of Organ Dysfunction 2008;4(1):43‐50. CENTRAL

Manes 2003 {published data only}

Manes G, Rabitti PG, Menchise A, Riccio E, Balzano A, Uomo G. Prophylaxis with meropenem of septic complications in acute pancreatitis: a randomized, controlled trial versus imipenem. Pancreas 2003;27(4):e79‐83. CENTRAL

Manes 2006 {published data only}

Manes G, Uomo I, Menchise A, Rabitti PG, Ferrara EC, Uomo G. Timing of antibiotic prophylaxis in acute pancreatitis: a controlled randomized study with meropenem. American Journal of Gastroenterology 2006;101(6):1348‐53. CENTRAL

McClave 2009 {published data only}

McClave SA, Heyland DK, Wischmeyer PE. Probiotic prophylaxis in predicted severe acute pancreatitis: a randomized, double‐blind, placebo‐controlled trial. Journal of Parenteral and Enteral Nutrition 2009;33(4):444‐6. CENTRAL

Mercadier 1973 {published data only}

Mercadier M, Chigot JP, Clot JP. Has glucagon a value in the treatment of acute pancreatitis? [Le glucagon a‐t‐il un intert dans le traitement des pancreatites aigues]. Nouvelle Presse Medicale 1973;2(40):2692. CENTRAL

Niu 2014 {published data only}

Niu G, Zhao R, Gao F, Zheng D, Liu X, Wu H, et al. Effect of omega‐3 polyunsaturated fatty acids on intestinal mucosal barrier of patients with severe acute pancreatitis. Zhongguo Linchuang Yingyang Zazhi [Chinese Journal of Clinical Nutrition] 2014;22(6):329‐33. CENTRAL

Pearce 2006 {published data only}

Pearce CB, Sadek SA, Walters AM, Goggin PM, Somers SS, Toh SK, et al. A double‐blind, randomised, controlled trial to study the effects of an enteral feed supplemented with glutamine, arginine, and omega‐3 fatty acid in predicted acute severe pancreatitis. Journal of the Pancreas 2006;7(4):361‐71. CENTRAL

Pederzoli 1995 {published data only}

Pederzoli P, Bassi C, Falconi M, De Santis L, Uomo G, Rabitti PG, et al. Gabexate mesilate in the treatment of acute pancreatitis. Annali Italiani di Chirurgia 1995;66(2):191‐5. CENTRAL

Pezzilli 1997 {published data only}

Pezzilli R, Dragonetti C, Innocenti P, Miglioli M. A multicenter, open label, copmarative, randomized study of two schedules of gabexate mesilate (1500 mg/day vs. 900 mg/day) for the treatment of severe acute pancreatitis. An interim report [abstract]. Italian Journal of Gastroenterology and Hepatology 1997;29(Suppl 1):A7. Abstract 17. CENTRAL

Pezzilli 1999 {published data only}

Pezzilli R, Dragonetti C, Innocenti P, Miglioli M. Amulticenter, open label, comparative, randomized study of two schedules of gabexate mesilate for the treatment of severe acute pancreatitis.[abstract]. Gut 1999;45(Suppl V):A315. CENTRAL

Pezzilli 2001 {published data only}

Pezzilli R, Miglioli M. Multicentre comparative study of two schedules of gabexate mesilate in the treatment of acute pancreatitis. Digestive and Liver Disease 2001;33(1):49‐57. CENTRAL

Piascik 2010 {published data only}

Piascik M, Rydzewska G, Milewski J, Olszewski S, Furmanek M, Walecki J, et al. The results of severe acute pancreatitis treatment with continuous regional arterial infusion of protease inhibitor and antibiotic: a randomized controlled study. Pancreas 2010;39(6):863‐7. CENTRAL

Plaudis 2012 {published data only}

Plaudis H, Pupelis G, Zeiza K, Boka V. Early low volume oral synbiotic/prebiotic supplemented enteral stimulation of the gut in patients with severe acute pancreatitis: a prospective feasibility study. Acta Chirurgica Belgica 2012;112(2):131‐8. CENTRAL

Rahman 2003 {published data only}

Rahman SH, Catton JA, McMahon MJ. Letter 2: Randomized clinical trial of specific lactobacillus and fibre supplement to early enteral nutrition in patients with acute pancreatitis (Br J Surg 2002; 89: 1103‐1107) [comment]. British Journal of Surgery 2003;90(1):123. CENTRAL

Ranson 1976 {published data only}

Ranson JH, Rifkind KM, Turner JW. Prognostic signs and nonoperative peritoneal lavage in acute pancreatitis. Surgery, Gynecology & Obstetrics 1976;143(2):209‐19. CENTRAL

Reddy 2008 {published data only}

Reddy BS, MacFie J. Probiotic prophylaxis in predicted severe acute pancreatitis. Lancet 2008;372(9633):113‐. CENTRAL

Santen 2008 {published data only}

Santen GW, Benus RF, van der Werf TS. Probiotic prophylaxis in patients with predicted severe acute pancreatitis: a randomised, double‐blind, placebo‐controlled trial and informed consent procedure [Probioticaprofylaxe bij voorspeld ernstige acute pancreatitis; gerandomiseerde, dubbelblinde, placebogecontroleerde trial en informed‐consentprocedure]. Nederlands Tijdschrift voor Geneeskunde 2008;152(28):1591; author reply 3‐4. CENTRAL

Singer 1966 {published data only}

Singer A, Tornya P, Skyring A. Double‐blind study of trasylol in treatment of acute pancreatitis. Gut 1966;7(3):304‐&. CENTRAL

Skyring 1965 {published data only}

Skyring A, Singer A, Tornya P. Treatment of acute pancreatitis with trasylol: report of a controlled therapeutic trial. British Medical Journal 1965;2(5462):627‐9. CENTRAL

Tanaka 1979 {published data only}

Tanaka N, Tsuchiya R, Ishii K. Comparative clinical study of foy and trasylol in acute pancreatitis. Advances in Experimental Medicine and Biology 1979;120 B:367‐78. CENTRAL

Tang 2005 {published data only}

Tang WF, Wan MH, Zhu L, Chen GY, Xia Q, Huang X. Immuno‐modulatory effect of somatostatin combined with traditional Chinese medicine on severe acute pancreatitis at early stage: a randomized control trial. Zhongxiyi Jiehe Xuebao [Journal of Chinese Integrative Medicine] 2005;3(2):103‐7. CENTRAL

Tang 2007 {published data only}

Tang WF, Wang YG, Zhu L, Wan MH, Chen GY, Xia Q, et al. Effect of somatostatin on immune inflammatory response in patients with severe acute pancreatitis. Multiphase Pumping and Technologies Conference and Exhibition 2007 2007;8(2):96‐102. CENTRAL

Ukai 2015 {published data only}

Ukai T, Shikata S, Inoue M, Noguchi Y, Igarashi H, Isaji S, et al. Early prophylactic antibiotics administration for acute necrotizing pancreatitis: A meta‐analysis of randomized controlled trials. Journal of Hepato‐biliary‐pancreatic Sciences 2015;22(4):316‐21. CENTRAL

Usadel 1980 {published data only}

Usadel KH, Leuschner U, Uberla KK. Treatment of acute pancreatitis with somatostatin: a multicenter double blind study. New England Journal of Medicine 1980;303(17):999‐1000. CENTRAL

Venkatesan 2008 {published data only}

Venkatesan T. Probiotic prophylaxis in predicted severe acute pancreatitis: a randomised, double‐blind, placebo‐controlled trial. Nutrition in Clinical Practice 2008;23(6):662‐3. CENTRAL

Villatoro 2010 {published data only}

Villatoro E, Mulla M, Larvin M. Antibiotic therapy for prophylaxis against infection of pancreatic necrosis in acute pancreatitis. Cochrane Database of Systematic Reviews 2010, Issue 5. [DOI: 10.1002/14651858.CD002941.pub3]CENTRAL

Wang 2008 {published data only}

Wang X, Li W, Li N, Li J. Omega‐3 fatty acids ‐ supplemented parenteral nutrition decreases hyperinflammatory response and attenuates systemic disease sequelae in severe acute pancreatitis: a randomized and controlled study. Journal of Parenteral and Enteral Nutrition 2008;32(3):236‐41. CENTRAL

Wang 2009 {published data only}

Wang X, Li W, Zhang F, Pan L, Li N, Li J. Fish oil‐supplemented parenteral nutrition in severe acute pancreatitis patients and effects on immune function and infectious risk: a randomized controlled trial. Inflammation 2009;32(5):304‐9. CENTRAL

Weismann 2010 {published data only}

Weismann D, Maier SKG. Activated protein C in acute pancreatitis ‐ a double‐blind, randomized, placebo‐controlled study [Aktiviertes protein C bei akuter pankreatitis – eine doppelblinde, randomisierte, placebo‐kontrollierte studie]. Medizinische Klinik 2010;105(10):747. CENTRAL

Wyncoll 1998 {published data only}

Wyncoll DL, Beale RJ. Prospective placebo‐controlled randomized trial of lexipafant in predicted severe acute pancreatitis. The British Journal of Surgery 1998;85(2):279‐80. CENTRAL

Xiong 2009 {published data only}

Xiong J, Zhu S, Zhou Y, Wu H, Wang C. Regulation of omega‐3 fish oil emulsion on the sirs during the initial stage of severe acute pancreatitis. Journal of Huazhong University of Science and Technology ‐ Medical Science 2009;29(1):35‐8. CENTRAL

Xu 2012 {published data only}

Xu QH, Cai GL, Lu XC, Hu CB, Chen J, Yan J. The effects of omega‐3 fish oil lipid emulsion on inflammation‐immune response and organ function in patients with severe acute pancreatitis. Zhonghua Neike Zazhi [Chinese Journal of Internal Medicine] 2012;51(12):962‐5. CENTRAL

Yang 2008a {published data only}

Yang JS, Hou Y, Zuo Y. Effect of combined therapy with sandostatin and yiyan mixture in treating severe acute pancreatitis. Zhongguo Zhongxiyi Jiehe Zqzhi [Chinese Journal of Integrated Traditional and Western Medicine] 2008;28(8):708‐10. CENTRAL

Yang 2008b {published data only}

Yang SQ, Xu JG. Effect of glutamine on serum interleukin‐8 and tumor necrosis factor‐alpha levels in patients with severe pancreatitis. Nanfang Yeie Daxue Xuebao [Journal of Southern Medical University] 2008;28(1):129‐31. CENTRAL

Yang 2009 {published data only}

Yang XN, Deng LH, Xue P, Zhao L, Jin T, Wan MH, et al. Non‐preventive use of antibiotics in patients with severe acute pancreatitis treated with integrated traditional Chinese and western medicine therapy: a randomized controlled trial. Zhongxiyi Jiehe Xuebao [Journal of Chinese Integrative Medicine] 2009;7(4):330‐3. CENTRAL

Zapater 2000 {published data only}

Zapater P, Abad‐Santos F, Alcalde‐Rubio M, Moreno‐Otero R. Do muscarinic receptors play a role in acute pancreatitis? A randomised comparison of pirenzepine and nasogastric suction. Clinical Drug Investigation 2000;20(6):401‐8. CENTRAL

Hansen 1966 {published data only}

Hansen HT, Drube HC, Brüning W, Borm D. Therapy of acute pancreatitis with and without proteinase inhibitor. Comparative clinical studies with trasylol [Behandlung der akuten pankreatitis mit und ohne proteinaseninhibitor. Vergleichende klinische untersuchungen mit trasylol]. Medizinische Klinik 1966;61(32):1254‐7. CENTRAL

Perez 1980 {published data only}

Perez Oteyza C, Rebollar J, Ballarin M. Treatment of acute pancreatitis with cimetidine. Double‐blind controlled trial. Hepato‐Gastroenterology 1980;27(Suppl):F8.2. CENTRAL

ChiCTR‐IPR‐16008301 {published data only}

ChiCTR‐IPR‐16008301. The effect of proton pump inhibitors on acute pancreatitis‐‐a randomly prospective control study [The effect of proton pump inhibitors on acute pancreatitis‐‐a randomly prospective control study]. www.chictr.org.cn/showproj.aspx?proj=14089 (first received 18 April 2016). CENTRAL

EUCTR2014‐004844‐37‐ES {published data only}

EUCTR2014‐004844‐37‐ES. Trial of indomethacin in pancreatitis [A randomized controlled pilot trial of indomethacin in acute pancreatitis]. www.clinicaltrialsregister.eu/ctr‐search/trial/2014‐004844‐37/ES (first received 8 May 2015). CENTRAL

NCT01132521 {published data only}

NCT01132521. Ulinastatin in severe acute pancreatitis [Multicenter, double‐bind, randomised, placebo controlled study of ulinastatin in severe acute pancreatitis]. clinicaltrials.gov/show/NCT01132521 (first received 26 May 2010). CENTRAL

NCT02025049 {published data only}

NCT02025049. DP‐b99 in the treatment of acute high‐risk pancreatitis [Pilot trial of intravenous DP‐b99 in the treatment of first‐ever episode of non‐obstructive acute high‐risk pancreatitis]. clinicaltrials.gov/show/NCT02025049 (first received 25 December 2013). CENTRAL

NCT02212392 {published data only}

NCT02212392. Comparing the outcome in patients of acute pancreatitis, with and without prophylactic antibiotics [Comparing the outcome in patients of acute pancreatitis, with and without prophylactic antibiotics]. clinicaltrials.gov/show/NCT02212392 (first received 5 August 2014). CENTRAL

NCT02692391 {published data only}

NCT02692391. A randomized controlled pilot trial of indomethacin in acute pancreatitis [A randomized controlled pilot trial of indomethacin in acute pancreatitis]. clinicaltrials.gov/show/NCT02692391 (first received 15 February 2016). CENTRAL

NCT02885441 {published data only}

NCT02885441. Treatment of acute pancreatitis with ketorolac [Treatment of acute pancreatitis with ketorolac]. clinicaltrials.gov/show/NCT02885441 (first received 23 August 2016). CENTRAL

Andriulli 1998

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Bang UC, Semb S, Nojgaard C, Bendtsen F. Pharmacological approach to acute pancreatitis. World Journal of Gastroenterology 2008;14(19):2968‐76.

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Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al. Classification of acute pancreatitis‐‐2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013;62(1):102‐11.

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Bradley EL. A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, GA, September 11‐13, 1992. Archives of Surgery 1993;128(5):586‐90.

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Characteristics of studies

Characteristics of included studies [ordered by study ID]

Ir a:

Abraham 2013

Methods

Randomised clinical trial

Participants

Country: India

Number randomised: 135

Postrandomisation dropouts: 6 (4.4%)

Revised sample size: 129

Average age: 39 years

Women: 13 (10.1%)

Acute interstitial oedematous pancreatitis: not stated

Necrotising pancreatitis: not stated

Mild pancreatitis: 62 (48.1%)

Moderate pancreatitis: not stated

Severe pancreatitis: 67 (51.9%)

Persistent organ failure: not stated

Infected pancreatitis: 0

Inclusion criteria

  1. Adults (18‐70 years)

  2. Acute pancreatitis (mild or severe)

  3. Elevated C‐reactive protein

Interventions

Group 1: ulinastatin (n = 30), 200,000 IU twice daily for 5 days

Group 2: placebo (n = 32)

Outcomes

Mortality, adverse events, organ failure, hospital stay

Follow‐up: until discharge or maximum of 22 days

Notes

Reasons for postrandomisation dropouts: withdrew consent, screening error, died

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "[r]andomized, double‐blind, placebo‐controlled, multi‐centre trial across 15 centres in India".

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "[r]andomized, double‐blind, placebo‐controlled, multi‐centre trial across 15 centres in India".

Incomplete outcome data (attrition bias)
All outcomes

High risk

Comment: there were postrandomisation dropouts

Selective reporting (reporting bias)

Low risk

Comment: mortality and adverse events were reported

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Low risk

Comment: no other risk of bias
Balldin 1983

Methods

Randomised clinical trial

Participants

Country: Sweden
Number randomised: 55
Postrandomisation dropouts: not stated
Revised sample size: 55
Average age: not stated
Women: 15 (27.3%)
Acute interstitial oedematous pancreatitis: not stated
Necrotising pancreatitis: not stated
Mild pancreatitis: not stated
Moderate pancreatitis: not stated
Severe pancreatitis: 55 (100%)
Persistent organ failure: not stated
Infected pancreatitis: not stated
Inclusion criteria: acute pancreatitis undergoing peritoneal lavage

Interventions

Group 1: aprotinin (n = 26), 500,000 KIU in lavage fluid every 2 h for an average of 2.7 days
Group 2: no intervention (n = 29)

Outcomes

Mortality, serious adverse events, adverse events, sepsis, hospital stay

Follow‐up: not stated (probably until discharge)

Notes

Reasons for postrandomisation dropouts: not stated

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Comment: this information was not available.

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Comment: this information was not available.

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Comment: this information was not available.

Selective reporting (reporting bias)

Low risk

Comment: mortality and adverse events were reported.

For profit‐bias

High risk

Comment: supported by grants from the ….Bayer AG….

Other bias

Low risk

Comment: no other risk of bias
Bansal 2011

Methods

Randomised clinical trial

Participants

Country: India

Number randomised: 44

Postrandomisation dropouts: 5 (11.4%)

Revised sample size: 39

Average age: 39 years

Women: 9 (23.1%)

Acute interstitial oedematous pancreatitis: not stated

Necrotising pancreatitis: not stated

Mild pancreatitis: not stated

Moderate pancreatitis: not stated

Severe pancreatitis: not stated

Persistent organ failure: not stated

Infected pancreatitis: not stated

Inclusion criteria: people with acute pancreatitis within 96 h of onset of symptoms

Exclusion criteria

  1. Age <18 or >75 years

  2. Pregnancy

  3. Acute pancreatitis secondary to surgery, trauma, or malignancy

  4. Psychosis (except alcoholic delirium)

  5. Need for urgent therapeutic intervention (endoscopic papillotomy, cholecystectomy, and/or choledochotomy)

  6. Those enrolled in any other trial

  7. People with serious diseases of the heart, brain, liver, or kidney

  8. Peptic ulcer

  9. Autoimmune disease

Interventions

Group 1: antioxidants (n = 19): vitamin A, C, E ‐ initially parenterally and then orally when the participant could consume orally for a total of 14 days
Group 2: no intervention (n = 20)

Outcomes

Mortality, serious adverse events, adverse events, organ failure, hospital stay

Follow‐up: until discharge

Notes

Reasons for postrandomisation dropouts: lost to follow‐up, withdrew consent

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Quote: "[t]his was a single‐center, prospective randomized, open‐label with blinded endpoint assessment study of antioxidant therapy".

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "[t]his was a single‐center, prospective randomized, open‐label with blinded endpoint assessment study of antioxidant therapy".

Incomplete outcome data (attrition bias)
All outcomes

High risk

Comment: there were postrandomisation dropouts.

Selective reporting (reporting bias)

Low risk

Comment: mortality and adverse events were reported.

For profit‐bias

Low risk

Quote: "[s]ource of support: Nil".

Other bias

Low risk

Comment: no other risk of bias.
Barreda 2009

Methods

Randomised clinical trial

Participants

Country: Peru

Number randomised: 80

Postrandomisation dropouts: 22 (27.5%)

Revised sample size: 58

Average age: 50 years

Women: 24 (41.4%)

Acute interstitial oedematous pancreatitis: 0 (0%)

Necrotising pancreatitis: 58 (100%)

Mild pancreatitis: not stated

Moderate pancreatitis: not stated

Severe pancreatitis: not stated

Persistent organ failure: not stated

Infected pancreatitis: not stated

Inclusion criteria: people with necrotising pancreatitis

Exclusion criteria

  1. Treated in other institutions for more than 4 days

  2. Received other prophylactic antibiotics

Interventions

Group 1: antibiotics (n = 24): imipenem 500 mg 4 times daily for 14 days
Group 2: no intervention (n = 34)

Outcomes

Mortality, serious adverse events, adverse events, infected pancreatic necrosis, requirement for additional intervention, length of hospital stay

Follow‐up: 2 months

Notes

Reasons for postrandomisation dropouts: protocol violations

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Low risk

Quote: "sealed envelopes".

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Comment: this information was not available.

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Comment: this information was not available.

Incomplete outcome data (attrition bias)
All outcomes

High risk

Comment: there were postrandomisation dropouts.

Selective reporting (reporting bias)

Low risk

Comment: mortality and adverse events were reported.

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Low risk

Comment: no other risk of bias
Berling 1994

Methods

Randomised clinical trial

Participants

Country: multicentric, international

Number randomised: 48

Postrandomisation dropouts: not stated

Revised sample size: 48

Average age: 56 years

Women: 17 (35.4%)

Acute interstitial oedematous pancreatitis: not stated

Necrotising pancreatitis: not stated

Mild pancreatitis: 0 (0%)

Moderate pancreatitis: 0 (0%)

Severe pancreatitis: 48 (100%)

Persistent organ failure: not stated

Infected pancreatitis: not stated

Inclusion criteria: participants with acute severe pancreatitis with circulatory insufficiency or peritonitis

Exclusion criteria

  1. People who had several surgeries before

  2. Renal failure

  3. Previous allergy to aprotinin or history of severe allergies

  4. Age < 15 years

  5. Pregnant women

Interventions

Group 1: aprotinin (n = 22), 20 million KIU in 7 lavages over 30 h
Group 2: no intervention (n = 26)

Outcomes

Mortality, serious adverse events, adverse events, requirement for surgery, sepsis, hospital stay, ICU stay

Follow‐up: 1 month

Notes

Reasons for postrandomisation dropouts: not stated

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Low risk

Quote: "[t]he Bayer . . . and was also responsible for coding the bottles."

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "prospective double‐blind randomized multicenter trial"

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "prospective double‐blind randomized multicenter trial"

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Comment: there were no postrandomisation dropouts.

Selective reporting (reporting bias)

Low risk

Comment: mortality and adverse events were reported.

For profit‐bias

High risk

Quote: "[t]his study was supported by grants from Bayer AG".

Other bias

Low risk

Comment: no other risk of bias
Besselink 2008

Methods

Randomised clinical trial

Participants

Country: Netherlands
Number randomised: 298
Postrandomisation dropouts: 2 (0.7%)
Revised sample size: 296
Average age: 60 years
Women: 122 (41.2%)
Acute interstitial oedematous pancreatitis: not stated
Necrotising pancreatitis: not stated
Mild pancreatitis: not stated
Moderate pancreatitis: not stated
Severe pancreatitis: not stated
Persistent organ failure: not stated
Infected pancreatitis: not stated
Inclusion criteria: people with predicted severe acute pancreatitis

Interventions

Group 1: probiotics (n = 152): ecologic 641 (maximum of 28 days or until development of pancreatic necrosis or fluid collection)
Group 2: placebo (n = 144)

Outcomes

Mortality, serious adverse events, adverse events, requirement for surgery, organ failure, infected pancreatic necrosis, hospital stay, ICU stay

Follow‐up: 3 months

Notes

Reasons for postrandomisation dropouts: did not receive drug, wrong diagnosis of acute pancreatitis

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Quote: "[r]andomisation was done with a computer‐generated permuted‐block sequence.".

Allocation concealment (selection bias)

Low risk

Quote: "[b]oth the probiotic and placebo preparations were packaged in identical, numbered sachets that were stored in identical, numbered containers."

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "[a]ll doctors, nurses, research staff , and patients involved remained unaware of the actual product administered during the entire study period."

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "[a]ll doctors, nurses, research staff , and patients involved remained unaware of the actual product administered during the entire study period."

Incomplete outcome data (attrition bias)
All outcomes

High risk

Comment: there were postrandomisation dropouts.

Selective reporting (reporting bias)

Low risk

Comment: mortality and adverse events were reported.

For profit‐bias

High risk

Quote: "HMT is an employee of Winclove Bio Industries, Amsterdam".

Other bias

Low risk

Comment: no other risk of bias
Birk 1994

Methods

Randomised clinical trial

Participants

Country: Germany
Number randomised: 20
Postrandomisation dropouts: not stated
Revised sample size: 20
Average age: not stated
Women: not stated
Acute interstitial oedematous pancreatitis: not stated
Necrotising pancreatitis: not stated
Mild pancreatitis: not stated
Moderate pancreatitis: not stated
Severe pancreatitis: 20 (100%)
Persistent organ failure: not stated
Infected pancreatitis: not stated
Inclusion criteria: people with severe acute pancreatitis

Interventions

Group 1: antioxidants (n = 10): sodium selenite 600 μg/day for 8 days
Group 2: no intervention (n = 10)

Outcomes

None of the outcomes of interest were reported.

Follow‐up: not stated (probably until discharge)

Notes

Reasons for postrandomisation dropouts: not stated

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Comment: this information was not available.

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Comment: this information was not available.

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Comment: this information was not available.

Selective reporting (reporting bias)

High risk

Comment: either mortality or adverse events were not reported.

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Low risk

Comment: no other risk of bias.
Bredkjaer 1988

Methods

Randomised clinical trial

Participants

Country: Denmark

Number randomised: 66

Postrandomisation dropouts: 9 (13.6%)

Revised sample size: 57

Average age: not stated

Women: 26 (45.6%)

Acute interstitial oedematous pancreatitis: not stated

Necrotising pancreatitis: not stated

Mild pancreatitis: not stated

Moderate pancreatitis: not stated

Severe pancreatitis: not stated

Persistent organ failure: not stated

Infected pancreatitis: not stated

Inclusion criteria: people with acute pancreatitis

Exclusion criteria:

  1. Chronic pancreatitis

  2. Previous pseudocyst

  3. Malignancy

  4. Gastroduodenal ulcer

  5. Coagulation disease

Interventions

Group 1: NSAID (n = 27): indomethacin 100 mg rectal for 7 days
Group 2: placebo (n = 30)

Outcomes

The outcomes reported were: hospital stay

Follow‐up: not stated (probably until discharge)

Notes

Reasons for postrandomisation dropouts: chronic pancreatitis, wrong diagnosis, death

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Comment: this information was not available.

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Comment: this information was not available.

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Comment: this information was not available.

Selective reporting (reporting bias)

High risk

Comment: either mortality or adverse events were not reported.

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Low risk

Comment: no other risk of bias
Buchler 1993

Methods

Randomised clinical trial

Participants

Country: Germany

Number randomised: 223

Postrandomisation dropouts: not stated

Revised sample size: 223

Average age: 50 years

Women: 87 (39%)

Acute interstitial oedematous pancreatitis: not stated

Necrotising pancreatitis: not stated

Mild pancreatitis: not stated

Moderate pancreatitis: not stated

Severe pancreatitis: not stated

Persistent organ failure: not stated

Infected pancreatitis: not stated

Inclusion criteria: people with moderate or severe acute pancreatitis

Exclusion criteria

  1. Pre‐existing renal insufficiency

  2. Age < 18 years

  3. Pregnancy

  4. Psychosis

  5. Previous treatment with aprotinin, glucagon, calcitonin, or somatostatin

  6. Previous participation in the study

Interventions

Group 1: gabexate mesilate (n = 115), 53 mg/kg/day for 7 days
Group 2: placebo (n = 108)

Outcomes

Mortality, serious adverse events, adverse events, requirement for surgery, sepsis, hospital stay

Follow‐up: 3 months

Notes

Reasons for postrandomisation dropouts: not stated

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Quote: "[a] randomization list was applied to get a random sequence of GM and placebos for increasing package numbers."

Allocation concealment (selection bias)

Low risk

Quote: "[t]he drug packages for each hospital were numbered sequentially and the package number was used as patient number"

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "randomized, double‐blind trial"

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "randomized, double‐blind trial"

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Comment: there were no postrandomisation dropouts.

Selective reporting (reporting bias)

Low risk

Comment: mortality and adverse events were reported.

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Low risk

Comment: no other risk of bias
Chen 2000

Methods

Randomised clinical trial

Participants

Country: Taiwan
Number randomised: 52
Postrandomisation dropouts: not stated
Revised sample size: 52
Average age: 44 years
Women: 15 (28.8%)
Acute interstitial oedematous pancreatitis: not stated
Necrotising pancreatitis: not stated
Mild pancreatitis: 0 (0%)
Moderate pancreatitis: 0 (0%)
Severe pancreatitis: 0 (0%)
Persistent organ failure: 52 (100%)
Infected pancreatitis: not stated
Inclusion criteria: people with severe acute pancreatitis with organ failure

Interventions

Group 1: gabexate mesilate (n = 26), 100 mg/h for 7 days
Group 2: placebo (n = 26)

Outcomes

Mortality, serious adverse events, adverse events, requirement for surgery

Follow‐up: 3 months

Notes

Reasons for postrandomisation dropouts: not stated

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Comment: this information was not available.

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Comment: this information was not available.

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Comment: this information was not available.

Selective reporting (reporting bias)

Low risk

Comment: mortality and adverse events were reported.

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Unclear risk

Comment: this information was not available.
Chen 2002a

Methods

Randomised clinical trial

Participants

Country: China
Number randomised: 68
Postrandomisation dropouts: 6 (8.8%)
Revised sample size: 62
Average age: 53 years
Women: 33 (53.2%)
Acute interstitial oedematous pancreatitis: 62 (100%)
Necrotising pancreatitis: 0 (0%)
Mild pancreatitis: 62 (100%)
Moderate pancreatitis: 0 (0%)
Severe pancreatitis: 0 (0%)
Persistent organ failure: 0 (0%)
Infected pancreatitis: not stated
Inclusion criteria: people with mild pancreatitis

Interventions

Group 1: ulinastatin (n = 48), 50,000 IU twice daily for 3 days followed by once daily for 5 days
Group 2: gabexate mesilate (n = 14), 100 mg twice daily for 3 days followed by once daily for 5 days

Outcomes

Serious adverse events, adverse events

Follow‐up: not stated (probably 2 weeks)

Notes

Reasons for postrandomisation dropouts: recent or current treatment with other drugs

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Comment: this information was not available.

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Comment: this information was not available.

Incomplete outcome data (attrition bias)
All outcomes

High risk

Comment: there were postrandomisation dropouts.

Selective reporting (reporting bias)

High risk

Comment: either mortality or adverse events were not reported.

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Low risk

Comment: no other risk of bias
Chen 2002b

Methods

Randomised clinical trial

Participants

Country: China
Number randomised: 26
Postrandomisation dropouts: 1 (3.8%)
Revised sample size: 25
Average age: 59 years
Women: 12 (48%)
Acute interstitial oedematous pancreatitis: 0 (0%)
Necrotising pancreatitis: 15 (60%)
Mild pancreatitis: 0 (0%)
Moderate pancreatitis: 0 (0%)
Severe pancreatitis: 25 (100%)
Persistent organ failure: not stated
Infected pancreatitis: not stated
Inclusion criteria: people with severe necrotising pancreatitis

Interventions

Group 1: ulinastatin (n = 14), 100,000 IU twice daily for 3 days followed by 50,000 IU once daily for 5‐10 days
Group 2: octreotide (n = 11), 0.3 mg twice daily for 3 days followed by 0.1 mg once daily for 5 days

Outcomes

Adverse events

Follow‐up: not stated (probably 2 weeks)

Notes

Reasons for postrandomisation dropouts: death after starting treatment

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Comment: this information was not available.

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Comment: this information was not available.

Incomplete outcome data (attrition bias)
All outcomes

High risk

Comment: there were postrandomisation dropouts.

Selective reporting (reporting bias)

High risk

Comment: either mortality or adverse events were not reported.

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Low risk

Comment: no other risk of bias
Choi 1989

Methods

Randomised clinical trial

Participants

Country: Hong Kong, China
Number randomised: 71
Postrandomisation dropouts: not stated
Revised sample size: 71
Average age: 61 years
Women: 39 (54.9%)
Acute interstitial oedematous pancreatitis: not stated
Necrotising pancreatitis: not stated
Mild pancreatitis: not stated
Moderate pancreatitis: not stated
Severe pancreatitis: 15 (21.1%)
Persistent organ failure: not stated
Infected pancreatitis: not stated
Inclusion criteria: people with acute pancreatitis

Exclusion criteria: people with acute pancreatitis caused by trauma, iatrogenic, or malignancy

Interventions

Group 1: somatostatin (n = 35), 250 μg bolus followed by 100 μg/h for 48 h
Group 2: no intervention (n = 36)

Outcomes

Mortality, serious adverse events, adverse events

Follow‐up: not stated (probably until discharge)

Notes

Reasons for postrandomisation dropouts: not stated

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Low risk

Quote: "[r]andomisation was done by drawing sealed envelopes"

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Comment: this information was not available.

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Comment: this information was not available.

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Comment: this information was not available.

Selective reporting (reporting bias)

Low risk

Comment: mortality and adverse events were reported.

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Low risk

Comment: no other risk of bias
Chooklin 2007

Methods

Randomised clinical trial

Participants

Country: Ukraine
Number randomised: 34
Postrandomisation dropouts: not stated
Revised sample size: 34
Average age: not stated
Women: not stated
Acute interstitial oedematous pancreatitis: not stated
Necrotising pancreatitis: not stated
Mild pancreatitis: not stated
Moderate pancreatitis: not stated
Severe pancreatitis: 34 (100%)
Persistent organ failure: not stated
Infected pancreatitis: not stated
Inclusion criteria: people with acute pancreatitis

Interventions

Group 1: antioxidants (N‐acetyl cysteine, unspecified dose and duration) plus corticosteroids (dexamethasone, unspecified dose and duration) (n = 16)
Group 2: no intervention (n = 18)

Outcomes

None of the outcomes of interest were reported.

Follow‐up: not stated (probably until discharge)

Notes

Reasons for postrandomisation dropouts: not stated

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Comment: this information was not available.

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Comment: this information was not available.

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Comment: this information was not available.

Selective reporting (reporting bias)

Low risk

Comment: either mortality or adverse events were not reported.

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Unclear risk

Comment: no other risk of bias
Debas 1980

Methods

Randomised clinical trial

Participants

Country: Canada
Number randomised: 66
Postrandomisation dropouts: not stated
Revised sample size: 66
Average age: 53 years
Women: 25 (37.9%)
Acute interstitial oedematous pancreatitis: not stated
Necrotising pancreatitis: not stated
Mild pancreatitis: not stated
Moderate pancreatitis: not stated
Severe pancreatitis: not stated
Persistent organ failure: not stated
Infected pancreatitis: not stated
Inclusion criteria: people with acute pancreatitis

Interventions

Group 1: glucagon (n = 33), 1 mg every 3 h (duration not stated)
Group 2: placebo (n = 33)

Outcomes

Mortality, serious adverse events, adverse events, hospital stay

Follow‐up: not stated (probably until discharge)

Notes

Reasons for postrandomisation dropouts: not stated

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Low risk

Quote: "[o]nce we decided to enter a patient into the study, the hospital pharmacy randomly assigned…"

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "[p]rospective randomized double‐blind study"

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "[p]rospective randomized double‐blind study"

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Comment: this information was not available.

Selective reporting (reporting bias)

Low risk

Comment: mortality and adverse events were reported.

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Low risk

Comment: no other risk of bias
Delcenserie 1996

Methods

Randomised clinical trial

Participants

Country: France

Number randomised: 23

Postrandomisation dropouts: 0 (0%)

Revised sample size: 23

Average age: 43 years

Women: 2 (8.7%)

Acute interstitial oedematous pancreatitis: not stated

Necrotising pancreatitis: not stated

Mild pancreatitis: not stated

Moderate pancreatitis: 23 (100%)

Severe pancreatitis: not stated

Persistent organ failure: not stated

Infected pancreatitis: not stated

Inclusion criteria

  1. People with severe acute pancreatitis (alcoholic)

  2. No previous pancreatic disease

  3. No previous antibiotic treatment

  4. Admission within 48 h of onset

Exclusion criteria

  1. Age <18 years

  2. Antibiotic allergy

  3. Need to carry out ERCP

Interventions

Group 1: antibiotics (n = 11), ceftazidime 2 g IV 3 times daily; amikacin 7.5 mg/kg IV BD; and metronidazole 0.5 g IV 3 times daily for 10 days
Group 2: no intervention (n = 12)

Outcomes

Mortality, serious adverse events, requirement for surgery, requirement for endoscopic or radiological drainage, organ failure, infected pancreatic necrosis, hospital stay

Follow‐up: not stated (probably until discharge)

Notes

—

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Quote: "random‐number table"

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Comment: this information was not available.

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Comment: this information was not available.

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Comment: there were no postrandomisation dropouts.

Selective reporting (reporting bias)

Low risk

Comment: mortality and adverse events were reported.

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Low risk

Comment: no other risk of bias
Delcenserie 2001

Methods

Randomised clinical trial

Participants

Country: France

Number randomised: 81

Postrandomisation dropouts: not stated

Revised sample size: 81

Average age: 47 years

Women: 14 (17.3%)

Acute interstitial oedematous pancreatitis: 0 (0%)

Necrotising pancreatitis: 81 (100%)

Mild pancreatitis: 0 (0%)

Moderate pancreatitis: not stated

Severe pancreatitis: not stated

Persistent organ failure: not stated

Infected pancreatitis: not stated

Inclusion criteria

  1. People with acute necrotising pancreatitis

  2. Within 48 h of onset of symptoms

  3. No previous antibiotic treatment

Interventions

Group 1: antibiotics (n = 53): ciprofloxacin for 7 days or 21 days (random choice); dose not stated
Group 2: no intervention (n = 28)

Outcomes

Mortality, serious adverse events

Follow‐up: not stated (probably until discharge)

Notes

Reasons for postrandomisation dropouts: not stated

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Comment: this information was not available.

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Comment: this information was not available.

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Comment: this information was not available.

Selective reporting (reporting bias)

Low risk

Comment: mortality and adverse events were reported.

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Low risk

Comment: no other risk of bias
Dellinger 2007

Methods

Randomised clinical trial

Participants

Country: multicentric, international

Number randomised: 100

Postrandomisation dropouts: 0 (0%)

Revised sample size: 100

Average age: 50 years

Women: 30 (30%)

Acute interstitial oedematous pancreatitis: 0 (0%)

Necrotising pancreatitis: 100 (100%)

Mild pancreatitis: 0 (0%)

Moderate pancreatitis: 0 (0%)

Severe pancreatitis: 100 (100%)

Persistent organ failure: not stated

Infected pancreatitis: 0

Inclusion criteria

  1. People with necrotising pancreatitis

  2. Within 5 days of onset of symptoms

Exclusion criteria

  1. People with concurrent pancreatic or peripancreatic infection

  2. Received meropenem within previous 30 days

  3. Antimicrobial therapy in previous 48 h

  4. Allergy to beta‐lactam antibiotics

  5. Received or likely to receive probenecid

  6. Pregnancy or lactation

  7. Neutropenia

  8. Decompensated cirrhosis

Interventions

Group 1: antibiotics (n = 50): meropenem 1 g IV 3 times daily for 7‐21 days (recommended duration: 14 days)
Group 2: placebo (n = 50)

Outcomes

Mortality, serious adverse events, adverse events, infected pancreatic necrosis

Follow‐up: 1.5 months

Notes

—

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Quote: "[t]he treatment given to each patient was determined by a random scheme prepared by the Biostatistics group at AstraZeneca (Wilmington, DE), using computer software that incorporates a standard procedure for generating random numbers"

Allocation concealment (selection bias)

Low risk

Quote: "[t]he treatment given to each patient was determined by a random scheme prepared by the Biostatistics group at AstraZeneca (Wilmington, DE), using computer software that incorporates a standard procedure for generating random numbers"

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "[r]andomized, double‐blind, placebo‐controlled study"

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "[r]andomized, double‐blind, placebo‐controlled study"

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Comment: there were no postrandomisation dropouts.

Selective reporting (reporting bias)

Low risk

Comment: mortality and adverse events were reported.

For profit‐bias

High risk

Quote: "[s]upported by a grant from AstraZeneca Pharmaceuticals"

Other bias

Low risk

Comment: no other risk of bias
Dürr 1978

Methods

Randomised clinical trial

Participants

Country: Germany
Number randomised: 69
Postrandomisation dropouts: not stated
Revised sample size: 69
Average age: 49 years
Women: 27 (39.1%)
Acute interstitial oedematous pancreatitis: not stated
Necrotising pancreatitis: not stated
Mild pancreatitis: not stated
Moderate pancreatitis: not stated
Severe pancreatitis: not stated
Persistent organ failure: not stated
Infected pancreatitis: not stated
Inclusion criteria: people with acute pancreatitis

Interventions

Group 1: glucagon (n = 33), 10 mg daily until surgery or at least 5 days in those who did not undergo surgery
Group 2: placebo (n = 36)

Outcomes

Mortality, requirement for surgery, hospital stay

Follow‐up: not stated (probably until discharge)

Notes

Reasons for postrandomisation dropouts: not stated

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "double‐blind"

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "double‐blind"

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Comment: this information was not available.

Selective reporting (reporting bias)

High risk

Comment: either mortality or adverse events were not reported.

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Low risk

Comment: no other risk of bias
Ebbehøj 1985

Methods

Randomised clinical trial

Participants

Country: Denmark
Number randomised: 30
Postrandomisation dropouts: 0 (0%)
Revised sample size: 30
Average age: 55 years
Women: 10 (33.3%)
Acute interstitial oedematous pancreatitis: not stated
Necrotising pancreatitis: not stated
Mild pancreatitis: not stated
Moderate pancreatitis: not stated
Severe pancreatitis: not stated
Persistent organ failure: not stated
Infected pancreatitis: not stated
Inclusion criteria: people with acute pancreatitis

Interventions

Group 1: NSAID (n = 14), indomethacin 50 mg PR twice daily for 7 days
Group 2: placebo (n = 16)

Outcomes

Hospital stay

Follow‐up: not stated (probably until discharge)

Notes

—

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "[c]ontrolled double‐blind trial".

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "[c]ontrolled double‐blind trial".

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Comment: there were no postrandomisation dropouts.

Selective reporting (reporting bias)

High risk

Comment: either mortality or adverse events were not reported.

For profit‐bias

High risk

Quote: "[i]ndomethacin (Confortid) and placebo were generously supplied by Dumex Ltd, Denmark".

Other bias

Low risk

Comment: no other risk of bias
Finch 1976

Methods

Randomised clinical trial

Participants

Country: USA

Number randomised: 62

Postrandomisation dropouts: 4 (6.5%)

Revised sample size: 58

Average age: 36 years

Women: 24 (41.4%)

Acute interstitial oedematous pancreatitis: not stated

Necrotising pancreatitis: not stated

Mild pancreatitis: not stated

Moderate pancreatitis: not stated

Severe pancreatitis: not stated

Persistent organ failure: not stated

Infected pancreatitis: not stated

Inclusion criteria: people with acute pancreatitis

Exclusion criteria

  1. History of blunt trauma

  2. Previous history compatible with gallstones

  3. Medications: steroids, thorazine, thiaziole diuretics

  4. Parathyroid disease

  5. Duodenal peptic ulcer disease

  6. A source of fever, independent of the pancreatitis

  7. Ancillary antibiotic coverage

Interventions

Group 1: antibiotics (n = 31): ampicillin 500 mg to 1 g 4 times daily for 7 days (keflin 1 g 4 times daily for 7 days in people allergic to penicillin)
Group 2: no intervention (n = 27)

Outcomes

Mortality, adverse events, hospital stay

Follow‐up: not stated (probably until discharge)

Notes

Reasons for postrandomisation dropouts: required surgery, developed pneumonia, went home against medical advice, malignancy

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Unclear risk

Quote: "[o]n a randomized pre‐selected basis a card was drawn to determine in which group (antibiotic treatment or non‐antibiotic treatment) the patient was to be included."
Comment: further details on whether the card was an open or held by a researcher not involved in recruitment are not available.

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Comment: this information was not available.

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Comment: this information was not available.

Incomplete outcome data (attrition bias)
All outcomes

High risk

Comment: there were postrandomisation dropouts.

Selective reporting (reporting bias)

Low risk

Comment: mortality and adverse events were reported.

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Low risk

Comment: no other risk of bias
Freise 1986

Methods

Randomised clinical trial

Participants

Country: Germany

Number randomised: 50

Postrandomisation dropouts: not stated

Revised sample size: 50

Average age: not stated

Women: 17 (34%)

Acute interstitial oedematous pancreatitis: not stated

Necrotising pancreatitis: not stated

Mild pancreatitis: not stated

Moderate pancreatitis: not stated

Severe pancreatitis: not stated

Persistent organ failure: not stated

Infected pancreatitis: not stated

Inclusion criteria: people with acute pancreatitis

Exclusion criteria

  1. Duration of symptoms more than 48 h

  2. < 18 years

  3. Pregnancy

  4. Chronic renal insufficiency

Interventions

Group 1: gabexate mesilate (n = 25), 150 mg IV 3 times daily for 7 days
Group 2: placebo (n = 25)

Outcomes

Mortality, serious adverse events, adverse events, organ failure, sepsis

Follow‐up: not stated

Notes

Reasons for postrandomisation dropouts: not stated

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Low risk

Comment: the drug code was concealed by third party.

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "double‐blind"

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "double‐blind"

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Comment: this information was not available.

Selective reporting (reporting bias)

Low risk

Comment: mortality and adverse events were reported.

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Low risk

Comment: no other risk of bias
Frulloni 1994

Methods

Randomised clinical trial

Participants

Country: Italy

Number randomised: 116

Postrandomisation dropouts: not stated

Revised sample size: 116

Average age: 57 years

Women: 49 (42.2%)

Acute interstitial oedematous pancreatitis: 0 (0%)

Necrotising pancreatitis: 116 (100%)

Mild pancreatitis: 0 (0%)

Moderate pancreatitis: not stated

Severe pancreatitis: not stated

Persistent organ failure: not stated

Infected pancreatitis: not stated

Inclusion criteria

  1. People with acute necrotising pancreatitis

  2. Within 72 h of onset of symptoms

  3. No skin sensitivity to aprotinin

Interventions

Group 1: gabexate mesilate (n = 65), 3 g/day for 7 days
Group 2: aprotinin (n = 51), 1.5 million KIU/day for 7 days

Outcomes

Mortality, serious adverse events, adverse events, sepsis

Follow‐up: 3 months

Notes

Reasons for postrandomisation dropouts: not stated

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Comment: this information was not available.

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Comment: this information was not available.

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Comment: this information was not available.

Selective reporting (reporting bias)

Low risk

Comment: mortality and adverse events were reported.

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Low risk

Comment: no other risk of bias
Garcia‐Barrasa 2009

Methods

Randomised clinical trial

Participants

Country: Spain
Number randomised: 46
Postrandomisation dropouts: 5 (10.9%)
Revised sample size: 41
Average age: 63 years
Women: 12 (29.3%)
Acute interstitial oedematous pancreatitis: 0 (0%)
Necrotising pancreatitis: 41 (100%)
Mild pancreatitis: 0 (0%)
Moderate pancreatitis: 0 (0%)
Severe pancreatitis: 41 (100%)
Persistent organ failure: not stated
Infected pancreatitis: not stated
Inclusion criteria: people with acute necrotising pancreatitis

Interventions

Group 1: antibiotics (n = 22): ciprofloxacin 300 mg twice daily for 10 days
Group 2: placebo (n = 19)

Outcomes

Mortality, serious adverse events, adverse events, requirement for surgery, organ failure, infected pancreatic necrosis, hospital stay, ICU stay

Follow‐up: not stated (probably until discharge)

Notes

Reasons for postrandomisation dropouts: 3 ‐ no confirmed necrosis; 2 fulminant pancreatitis

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "[p]rospective, randomized, placebo‐controlled, double‐blind study"

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "[p]rospective, randomized, placebo‐controlled, double‐blind study"

Incomplete outcome data (attrition bias)
All outcomes

High risk

Comment: there were postrandomisation dropouts.

Selective reporting (reporting bias)

Low risk

Comment: mortality and adverse events were reported.

For profit‐bias

Low risk

Quote: "[t]his study was promoted by the “Bellvitge Hospital” and has not received any grant or payment from the pharmaceutical industry".

Other bias

Low risk

Comment: no other risk of bias
Gilsanz 1978

Methods

Randomised clinical trial

Participants

Country: Spain

Number randomised: 62.

Postrandomisation dropouts: not stated

Revised sample size: 62

Average age: 52 years

Women: 44 (71%)

Acute interstitial oedematous pancreatitis: not stated

Necrotising pancreatitis: not stated

Mild pancreatitis: not stated

Moderate pancreatitis: 48 (77.4%)

Severe pancreatitis: 14 (22.6%)

Persistent organ failure: not stated

Infected pancreatitis: not stated

Inclusion criteria: people with acute pancreatitis

Exclusion criteria

  1. Post‐traumatic pancreatitis

  2. Postsurgical pancreatitis

  3. Previous pancreatitic bouts

Interventions

Group 1: glucagon (n = 31), 1 mg IV every 4 h (duration ‐ not stated)
Group 2: oxyphenonium gromomethylate (n = 31), 1 mg IV every 4 h (duration ‐ not stated)

Outcomes

Mortality, adverse events, requirement for surgery

Follow‐up: 24 months

Notes

Reasons for postrandomisation dropouts: not stated

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Low risk

Quote: "sealed envelope"

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "double‐blind"

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "double‐blind"

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Comment: this information was not available

Selective reporting (reporting bias)

Low risk

Comment: mortality and adverse events were reported.

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Low risk

Comment: no other risk of bias
Gjørup 1992

Methods

Randomised clinical trial

Participants

Country: Denmark

Number randomised: 63

Postrandomisation dropouts: not stated

Revised sample size: 63

Average age: 49 years

Women: 22 (34.9%)

Acute interstitial oedematous pancreatitis: not stated

Necrotising pancreatitis: not stated

Mild pancreatitis: not stated

Moderate pancreatitis: not stated

Severe pancreatitis: not stated

Persistent organ failure: not stated

Infected pancreatitis: not stated

Inclusion criteria

  1. People with first attack of acute pancreatitis

  2. Within 24 h of onset of symptoms

Interventions

Group 1: somatostatin (n = 33), 250 μg/h for 3 days
Group 2: placebo (n = 30)

Outcomes

Mortality, serious adverse events, adverse events, hospital stay

Follow‐up: not stated (probably until discharge)

Notes

Reasons for postrandomisation dropouts: not stated

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Low risk

Quote: "by selecting sealed envelopes"

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "double‐blinded trial"

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "double‐blinded trial"

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Comment: this information was not available.

Selective reporting (reporting bias)

Low risk

Comment: mortality and adverse events were reported.

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Low risk

Comment: no other risk of bias
Goebell 1979

Methods

Randomised clinical trial

Participants

Country: multicentric, international

Number randomised: 94

Postrandomisation dropouts: not stated

Revised sample size: 94

Average age: 55 years

Women: 37 (39.4%)

Acute interstitial oedematous pancreatitis: not stated

Necrotising pancreatitis: not stated

Mild pancreatitis: 29 (30.9%)

Moderate pancreatitis: 49 (52.1%)

Severe pancreatitis: 16 (17%)

Persistent organ failure: not stated

Infected pancreatitis: not stated

Inclusion criteria: people with acute pancreatitis

Exclusion criteria

  1. Serum creatinine levels above 5 mg/100 ml

  2. Post‐operative acute pancreatitis

Interventions

Group 1: calcitonin (n = 50), synthetic salmon calcitonin 20 μg 3 times daily for 6 days
Group 2: placebo (n = 44)

Outcomes

Mortality, adverse events, requirement for surgery, hospital stay

Follow‐up: not stated (probably until discharge)

Notes

Reasons for postrandomisation dropouts: not stated

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "double‐blind"

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "double‐blind"

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Comment: this information was not available.

Selective reporting (reporting bias)

Low risk

Comment: mortality and adverse events were reported.

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Low risk

Comment: no other risk of bias
Goebell 1988

Methods

Randomised clinical trial

Participants

Country: Germany
Number randomised: 162
Postrandomisation dropouts: 11 (6.8%)
Revised sample size: 151
Average age: not stated
Women: not stated
Acute interstitial oedematous pancreatitis: not stated
Necrotising pancreatitis: not stated
Mild pancreatitis: not stated
Moderate pancreatitis: not stated
Severe pancreatitis: not stated
Persistent organ failure: not stated
Infected pancreatitis: not stated
Inclusion criteria: people with moderate or severe pancreatitis

Interventions

Group 1: gabexate mesilate (n = 76), 150 mg every 2 h followed by 0.5 mg/kg/h for 7 days
Group 2: placebo (n = 75)

Outcomes

Mortality, serious adverse events, requirement for surgery

Follow‐up: 3 months

Notes

Reasons for postrandomisation dropouts: not stated

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "double‐blind"

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "double‐blind"

Incomplete outcome data (attrition bias)
All outcomes

High risk

Comment: there were postrandomisation dropouts.

Selective reporting (reporting bias)

Low risk

Comment: mortality and adverse events were reported.

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Low risk

Comment: no other risk of bias
Grupo Español 1996

Methods

Randomised clinical trial

Participants

Country: Spain
Number randomised: 70
Postrandomisation dropouts: 9 (12.9%)
Revised sample size: 61
Average age: not stated
Women: not stated
Acute interstitial oedematous pancreatitis: not stated
Necrotising pancreatitis: not stated
Mild pancreatitis: not stated
Moderate pancreatitis: not stated
Severe pancreatitis: 61 (100%)
Persistent organ failure: not stated
Infected pancreatitis: not stated
Inclusion criteria: people with severe acute pancreatitis

Interventions

Group 1: somatostatin (n = 30), 250 μg/h for 5 days
Group 2: placebo (n = 31)

Outcomes

Mortality

Follow‐up: not stated (probably until discharge)

Notes

Reasons for postrandomisation dropouts: did not complete the study

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "[r]andomized, double‐blind, placebo‐controlled, multi‐centre trial across 15 centres in India"

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "[r]andomized, double‐blind, placebo‐controlled, multi‐centre trial across 15 centres in India"

Incomplete outcome data (attrition bias)
All outcomes

High risk

Comment: there were postrandomisation dropouts.

Selective reporting (reporting bias)

High risk

Comment: either mortality or adverse events were not reported.

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Low risk

Comment: no other risk of bias
Guo 2015

Methods

Randomised clinical trial

Participants

Country: China
Number randomised: 120
Postrandomisation dropouts: not stated
Revised sample size: 120
Average age: 46 years
Women: 58 (48.3%)
Acute interstitial oedematous pancreatitis: not stated
Necrotising pancreatitis: not stated
Mild pancreatitis: 0 (0%)
Moderate pancreatitis: 0 (0%)
Severe pancreatitis: 120 (100%)
Persistent organ failure: not stated
Infected pancreatitis: not stated
Inclusion criteria: people with severe acute pancreatitis

Interventions

Group 1: octerotide plus ulinastatin (n = 60), 0.1 mg SC 3 times daily for 7‐14 days
Group 2: octreotide (n = 60), 10 million units IV continuous for 7‐14 days

Outcomes

Mortality, serious adverse events, adverse events, length of hospital stay

Follow‐up: not stated (probably until discharge)

Notes

—

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Comment: this information was not available.

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Comment: this information was not available.

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Comment: this information was not available.

Selective reporting (reporting bias)

Low risk

Comment: mortality and adverse events were reported.

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Low risk

Comment: no other risk of bias
Hansky 1969

Methods

Randomised clinical trial

Participants

Country: Australia
Number randomised: 24
Postrandomisation dropouts: not stated
Revised sample size: 24
Average age: not stated
Women: 7 (29.2%)
Acute interstitial oedematous pancreatitis: not stated
Necrotising pancreatitis: not stated
Mild pancreatitis: 3 (12.5%)
Moderate pancreatitis: 15 (62.5%)
Severe pancreatitis: 6 (25%)
Persistent organ failure: not stated
Infected pancreatitis: not stated
Inclusion criteria: people with acute pancreatitis

Interventions

Group 1: iniprol (n = 15), single IV dose of 1 million units, followed by 500,000 units IV 4 times daily for 4‐8 days depending upon clinical course
Group 2: no intervention (n = 9)

Outcomes

Mortality, hospital stay

Follow‐up: not stated (probably until discharge)

Notes

Reasons for postrandomisation dropouts: not stated

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Quote: "[t]he drug was not evaluated in a double‐blind manner".

Blinding of outcome assessment (detection bias)
All outcomes

High risk

Quote: "[t]he drug was not evaluated in a double‐blind manner".

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Comment: this information was not available.

Selective reporting (reporting bias)

High risk

Comment: either mortality or adverse events were not reported.

For profit‐bias

High risk

Quote: "I am grateful to Difrex (Australia) laboratories for supplying . . ."

Other bias

Low risk

Comment: no other risk of bias
Hejtmankova 2003

Methods

Randomised clinical trial

Participants

Country: not stated
Number randomised: 41
Postrandomisation dropouts: not stated
Revised sample size: 41
Average age: not stated
Women: not stated
Acute interstitial oedematous pancreatitis: not stated
Necrotising pancreatitis: not stated
Mild pancreatitis: not stated
Moderate pancreatitis: not stated
Severe pancreatitis: 41 (100%).
Persistent organ failure: not stated
Infected pancreatitis: not stated
Inclusion criteria: people with severe acute pancreatitis

Interventions

Group 1: antibiotics (n = 20): meropenem 500 mg 3 times daily for 10 days
Group 2: no intervention (n = 21)

Outcomes

Mortality, adverse events, requirement for surgery, hospital stay

Follow‐up: not stated (probably until discharge)

Notes

Reasons for postrandomisation dropouts: not stated

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Comment: this information was not available.

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Comment: this information was not available.

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Comment: this information was not available.

Selective reporting (reporting bias)

Low risk

Comment: mortality and adverse events were reported.

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Low risk

Comment: no other risk of bias
Imrie 1978

Methods

Randomised clinical trial

Participants

Country: UK

Number randomised: 161

Postrandomisation dropouts: not stated

Revised sample size: 161

Average age: 51 years

Women: 92 (57.1%)

Acute interstitial oedematous pancreatitis: not stated

Necrotising pancreatitis: not stated

Mild pancreatitis: not stated

Moderate pancreatitis: not stated

Severe pancreatitis: 60 (37.3%)

Persistent organ failure: not stated

Infected pancreatitis: not stated

Inclusion criteria: people with acute pancreatitis

Exclusion criteria

  1. Post‐traumatic pancreatitis

  2. Postsurgical pancreatitis

  3. Previous pancreatitic bouts

Interventions

Group 1: aprotinin (n = 80), 500 000 KIU bolus followed by 200 000 KIU 4 times daily for 5 days
Group 2: placebo (n = 81)

Outcomes

Mortality, serious adverse events, adverse events

Follow‐up: not stated (probably until discharge)

Notes

Reasons for postrandomisation dropouts: not stated

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Low risk

Quote: "sealed envelope".

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "double‐blind trial".

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "double‐blind trial".

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Comment: this information was not available.

Selective reporting (reporting bias)

Low risk

Comment: mortality and adverse events were reported.

For profit‐bias

High risk

Quote: "[i]n addition to providing both Trasylol and placebo, Bayer Pharmaceuticals contributed the financial support of a research assistant".

Other bias

Low risk

Comment: no other risk of bias
Imrie 1980

Methods

Randomised clinical trial

Participants

Country: UK
Number randomised: 50
Postrandomisation dropouts: not stated
Revised sample size: 50
Average age: not stated
Women: not stated
Acute interstitial oedematous pancreatitis: not stated
Necrotising pancreatitis: not stated
Mild pancreatitis: 29 (58%)
Moderate pancreatitis: not stated
Severe pancreatitis: 21 (42%)
Persistent organ failure: not stated
Infected pancreatitis: not stated
Inclusion criteria: people with acute pancreatitis

Interventions

Group 1: aprotinin (n = 25), 2 million units KIU bolus followed by 400,000 KIU 4 h later
Group 2: placebo (n = 25)

Outcomes

Mortality

Follow‐up: not stated (probably until discharge)

Notes

Reasons for postrandomisation dropouts: not stated

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "double‐blind trial"

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "double‐blind trial"

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Comment: this information was not available.

Selective reporting (reporting bias)

High risk

Comment: either mortality or adverse events were not reported.

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Low risk

Comment: no other risk of bias
Isenmann 2004

Methods

Randomised clinical trial

Participants

Country: Germany
Number randomised: 119
Postrandomisation dropouts: 5 (4.2%)
Revised sample size: 114
Average age: 47 years
Women: 27 (23.7%)
Acute interstitial oedematous pancreatitis: 38 (33.3%)
Necrotising pancreatitis: 76 (66.7%)
Mild pancreatitis: not stated
Moderate pancreatitis: not stated
Severe pancreatitis: not stated
Persistent organ failure: not stated
Infected pancreatitis: not stated
Inclusion criteria: people with predicted severe pancreatitis

Interventions

Group 1: antibiotics (n = 58): metronidazole 500 mg twice daily and ciprofloxacin 400 mg twice daily (duration not reported)
Group 2: placebo (n = 56)

Outcomes

Serious adverse events, adverse events, requirement for surgery, infected pancreatic necrosis, hospital stay, ICU stay

Follow‐up: not stated (probably until discharge)

Notes

Reasons for postrandomisation dropouts: lost to follow‐up, withdrawn from study prior to medication

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Low risk

Quote: "[s]tudy medication for each patient (verum or placebo) was packed in identical vials and labelled with consecutive patient numbers according to the randomization sequence".

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "double‐blind trial"

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "double‐blind trial"

Incomplete outcome data (attrition bias)
All outcomes

High risk

Comment: there were postrandomisation dropouts.

Selective reporting (reporting bias)

High risk

Comment: either mortality or adverse events were not reported.

For profit‐bias

High risk

Quote: "[s]upported by study medication provided from Bayer Vital and Ratiopharm as well as a financial grant from Bayer Vital"

Other bias

Low risk

Comment: no other risk of bias
Johnson 2001

Methods

Randomised clinical trial

Participants

Country: UK

Number randomised: 291

Postrandomisation dropouts: 1 (0.3%)

Revised sample size: 290

Average age: 63 years

Women: 124 (42.8%)

Acute interstitial oedematous pancreatitis: not stated

Necrotising pancreatitis: not stated

Mild pancreatitis: not stated

Moderate pancreatitis: not stated

Severe pancreatitis: not stated

Persistent organ failure: not stated

Infected pancreatitis: not stated

Inclusion criteria

  1. People with predicted severe acute pancreatitis

  2. Premenopausal women in whom pregnancy could not be excluded

  3. Pancreatitis secondary to trauma, surgery, malignancy, or ERCP

  4. Person unsuitable for ventilation

  5. Other investigational agents in the last 3 years

  6. People receiving oral anti‐coagulant therapy

  7. People who had received lexipafant previously

Exclusion criteria: age < 18 or > 80 years

Interventions

Group 1: lexipafant (n = 151), 100 mg daily for 7 days
Group 2: placebo (n = 139)

Outcomes

Mortality, serious adverse events, adverse events, organ failure, sepsis, hospital stay, ICU stay

Follow‐up: not stated (probably until discharge)

Notes

Reasons for postrandomisation dropouts: withdrew from the study

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "double blind, placebo controlled, randomised, parallel group"

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "double blind, placebo controlled, randomised, parallel group"

Incomplete outcome data (attrition bias)
All outcomes

High risk

Comment: there were postrandomisation dropouts.

Selective reporting (reporting bias)

Low risk

Comment: mortality and adverse events were reported.

For profit‐bias

High risk

Quote: "[t]his study was funded by British Biotech Pharmaceuticals Ltd, Oxford, UK".

Other bias

Low risk

Comment: no other risk of bias
Kalima 1980

Methods

Randomised clinical trial

Participants

Country: Finland
Number randomised: 80
Postrandomisation dropouts: 9 (11.3%)
Revised sample size: 71
Average age: 46 years
Women: 28 (39.4%)
Acute interstitial oedematous pancreatitis: not stated
Necrotising pancreatitis: not stated
Mild pancreatitis: not stated
Moderate pancreatitis: not stated
Severe pancreatitis: not stated
Persistent organ failure: not stated
Infected pancreatitis: not stated
Inclusion criteria: people with acute pancreatitis

Interventions

Group 1: glucagon (n = 32), 7.5 mg twice daily for 4‐5 days
Group 2: placebo (n = 29)

Outcomes

Mortality, serious adverse events, adverse events

Follow‐up: not stated (probably until discharge)

Notes

Reasons for postrandomisation dropouts: underwent surgery, wrong diagnosis

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Comment: although placebo was used, there was no mention of blinding.

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Comment: although placebo was used, there was no mention of blinding.

Incomplete outcome data (attrition bias)
All outcomes

High risk

Comment: there were postrandomisation dropouts

Selective reporting (reporting bias)

Low risk

Comment: mortality and adverse events were reported

For profit‐bias

Unclear risk

Comment: this information was not available

Other bias

Low risk

Comment: no other risk of bias
Kingsnorth 1995

Methods

Randomised clinical trial

Participants

Country: UK

Number randomised: 83

Postrandomisation dropouts: not stated

Revised sample size: 83

Average age: 59 years

Women: 41 (49.4%)

Acute interstitial oedematous pancreatitis: not stated

Necrotising pancreatitis: not stated

Mild pancreatitis: 54 (65.1%)

Moderate pancreatitis: not stated

Severe pancreatitis: 29 (34.9%)

Persistent organ failure: not stated

Infected pancreatitis: not stated

Inclusion criteria: people with acute pancreatitis within 48 h of onset of symptoms

Exclusion criteria

  1. Age < 18 years

  2. Unsterilised premenopausal women

  3. Concomitant anticoagulant therapy

Interventions

Group 1: lexipafant (n = 42), 15 mg 4 times daily for 3 days
Group 2: placebo (n = 41)

Outcomes

Mortality, adverse events

Follow‐up: 1 week

Notes

Reasons for postrandomisation dropouts: not stated

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "double‐blind"

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "double‐blind"

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Comment: this information was not available.

Selective reporting (reporting bias)

High risk

Comment: either mortality or adverse events were not reported.

For profit‐bias

High risk

Quote: "S.W.G. was supported by British Biotech, Oxford, UK"

Other bias

Low risk

Comment: no other risk of bias
Kirsch 1978

Methods

Randomised clinical trial

Participants

Country: Germany
Number randomised: 150
Postrandomisation dropouts: not stated
Revised sample size: 150
Average age: 53 years
Women: 78 (52%)
Acute interstitial oedematous pancreatitis: not stated
Necrotising pancreatitis: not stated
Mild pancreatitis: 35 (23.3%)
Moderate pancreatitis: 61 (40.7%)
Severe pancreatitis: 54 (36%)
Persistent organ failure: not stated
Infected pancreatitis: not stated
Inclusion criteria: people with acute pancreatitis

Interventions

Group 1: glucagon (n = 75), 10 mg/day for 4 days
Group 2: atropine (n = 75), 4 days (dose not stated)

Outcomes

Mortality, serious adverse events, adverse events

Follow‐up: not stated (probably until discharge)

Notes

Reasons for postrandomisation dropouts: not stated

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Comment: this information was not available.

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Comment: this information was not available.

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Comment: this information was not available.

Selective reporting (reporting bias)

Low risk

Comment: mortality and adverse events were reported.

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Low risk

Comment: no other risk of bias
Kronborg 1980

Methods

Randomised clinical trial

Participants

Country: Denmark

Number randomised: 22

Postrandomisation dropouts: not stated

Revised sample size: 22

Average age: not stated

Women: 4 (18.2%)

Acute interstitial oedematous pancreatitis: not stated

Necrotising pancreatitis: 11 (50%)

Mild pancreatitis: not stated

Moderate pancreatitis: not stated

Severe pancreatitis: not stated

Persistent organ failure: not stated

Infected pancreatitis: not stated

Inclusion criteria

  1. People with acute pancreatitis (first attack only)

  2. Deteriorating clinical condition or in shock

  3. No suspected biliary disease

Interventions

Group 1: glucagon (n = 10), 1 mg IV followed by 6 mg/day for 3 days
Group 2: placebo (n = 12)

Outcomes

Mortality, adverse events

Follow‐up: until discharge

Notes

Reasons for postrandomisation dropouts: not stated

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "double‐blind"

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "double‐blind"

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Comment: although authors stated they did not exclude any participants for wrong diagnosis, it was not clear whether they excluded participants for other reasons.

Selective reporting (reporting bias)

High risk

Comment: either mortality or adverse events were not reported.

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Low risk

Comment: no other risk of bias
Llukacaj 2012

Methods

Randomised clinical trial

Participants

Country: Albania
Number randomised: 80
Postrandomisation dropouts: not stated
Revised sample size: 80
Average age: not stated
Women: not stated
Acute interstitial oedematous pancreatitis: 0 (0%)
Necrotising pancreatitis: 80 (100%)
Mild pancreatitis: 0 (0%)
Moderate pancreatitis: not stated
Severe pancreatitis: not stated
Persistent organ failure: not stated
Infected pancreatitis: 0
Inclusion criteria: people with non‐infected necrotising pancreatitis

Interventions

Group 1: antibiotics (n = 40): imipenem 750 mg IV twice daily for 7 days
Group 2: placebo (n = 40)

Outcomes

Mortality, serious adverse events, adverse events, requirement for surgery, infected pancreatic necrosis

Follow‐up: 1 month

Notes

Reasons for postrandomisation dropouts: not stated

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "double‐blind"

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "double‐blind"

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Comment: although authors stated they did not exclude any participants for wrong diagnosis, it was not clear whether they excluded participants for other reasons.

Selective reporting (reporting bias)

High risk

Comment: either mortality or adverse events were not reported.

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Low risk

Comment: no other risk of bias
Luengo 1994

Methods

Randomised clinical trial

Participants

Country: Spain

Number randomised: 100

Postrandomisation dropouts: not stated

Revised sample size: 100

Average age: 55 years

Women: 39 (39%)

Acute interstitial oedematous pancreatitis: not stated

Necrotising pancreatitis: not stated

Mild pancreatitis: 78 (78%)

Moderate pancreatitis: not stated

Severe pancreatitis: 22 (22%)

Persistent organ failure: not stated

Infected pancreatitis: not stated

Inclusion criteria: people with acute pancreatitis

Exclusion criteria

  1. Pancreatitis following trauma, surgery, endoscopy, malignancy, drugs, or pregnancy

  2. Allergy to one of the antibiotics

  3. < 18 years of age

  4. Postoperative pancreatitis

  5. Infected pancreatic necrosis

Interventions

Group 1: somatostatin (n = 50), 250 μg/h for 48 h following a 250 μg bolus
Group 2: no intervention (n = 50)

Outcomes

Mortality, requirement for surgery, hospital stay

Follow‐up: not stated (probably until discharge)

Notes

Reasons for postrandomisation dropouts: not stated

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Low risk

Quote: "[p]atients were randomly divided by means of the sealed‐envelope method and grouped according to therapy".

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "double‐blind"

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "double‐blind"

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Comment: although authors stated they did not exclude any participants for wrong diagnosis, it was not clear whether they excluded participants for other reasons.

Selective reporting (reporting bias)

High risk

Comment: either mortality or adverse events were not reported.

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Low risk

Comment: no other risk of bias
Luiten 1995

Methods

Randomised clinical trial

Participants

Country: the Netherlands
Number randomised: 109
Postrandomisation dropouts: 7 (6.4%)
Revised sample size: 102
Average age: 55 years
Women: 42 (41.2%)
Acute interstitial oedematous pancreatitis: not stated
Necrotising pancreatitis: not stated
Mild pancreatitis: 0 (0%)
Moderate pancreatitis: 0 (0%)
Severe pancreatitis: 102 (100%)
Persistent organ failure: not stated
Infected pancreatitis: 0
Inclusion criteria: people with severe pancreatitis

Interventions

Group 1: antibiotics (n = 50): selective digestive decontamination using colistin 200 mg, amphotericin 500 mg, and norfloxacin 50 mg 4 times daily orally and as rectal enema along with short course of cefotaxime 500 mg IV 3 times daily until gram‐negative bacteria were eliminated from oral cavity and rectum. Total duration of treatment: until patient was extubated and taking oral feeds
Group 2: no intervention (n = 52)

Outcomes

Mortality, adverse events, requirement for surgery, hospital stay

Follow‐up: until discharge

Notes

Reasons for postrandomisation dropouts: perioperatively proven infected pancreatic necrosis or wrong clinical diagnosis

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Low risk

Quote: "[a] 24‐hour randomization service was available to randomize patients with stratification per center".

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Comment: this information was not available.

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Comment: this information was not available.

Incomplete outcome data (attrition bias)
All outcomes

High risk

Comment: there were postrandomisation dropouts.

Selective reporting (reporting bias)

Low risk

Comment: mortality and adverse events were reported.

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Low risk

Comment: no other risk of bias
Marek 1999

Methods

Randomised clinical trial

Participants

Country: Poland
Number randomised: 73
Postrandomisation dropouts: 0 (0%)
Revised sample size: 73
Average age: not stated
Women: not stated
Acute interstitial oedematous pancreatitis: not stated
Necrotising pancreatitis: not stated
Mild pancreatitis: 56 (76.7%)
Moderate pancreatitis: not stated
Severe pancreatitis: 17 (23.3%)
Persistent organ failure: not stated
Infected pancreatitis: not stated
Inclusion criteria: people with acute pancreatitis

Interventions

Group 1: antioxidants (n = 35): vitamin C 500 mg IV 3 times daily for 5 days
Group 2: placebo (n = 38)

Outcomes

None of the outcomes of interest were reported.

Follow‐up: not stated (probably until discharge)

Notes

—

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Comment: although a placebo was used, it was not clear blinding was performed.

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Comment: although a placebo was used, it was not clear blinding was performed.

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Comment: there were no postrandomisation dropouts.

Selective reporting (reporting bias)

High risk

Comment: either mortality or adverse events were not reported.

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Low risk

Comment: no other risk of bias
Martinez 1984

Methods

Randomised clinical trial

Participants

Country: Spain
Number randomised: 31
Postrandomisation dropouts: 0 (0%)
Revised sample size: 31
Average age: 48 years
Women: 6 (19.4%)
Acute interstitial oedematous pancreatitis: not stated
Necrotising pancreatitis: not stated
Mild pancreatitis: 0 (0%)
Moderate pancreatitis: 0 (0%)
Severe pancreatitis: 31 (100%)
Persistent organ failure: not stated
Infected pancreatitis: not stated
Inclusion criteria: people with severe acute pancreatitis

Interventions

Group 1: calcitonin (n = 14), synthetic salmon calcitonin 100 MRC units (equivalent to 100 IU) IV 3 times daily for 5 days or more
Group 2: placebo (n = 17)

Outcomes

Mortality, requirement for surgery, hospital stay

Follow‐up: not stated (probably until discharge)

Notes

—

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Comment: this information was not available.

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Comment: this information was not available.

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Comment: although some participants were excluded from hospital stay, they were included for mortality and requirement of surgical intervention.

Selective reporting (reporting bias)

High risk

Comment: either mortality or adverse events were not reported.

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Low risk

Comment: no other risk of bias
McKay 1997a

Methods

Randomised clinical trial

Participants

Country: UK

Number randomised: 58

Postrandomisation dropouts: 0 (0%)

Revised sample size: 58

Average age: 69 years

Women: 32 (55.2%)

Acute interstitial oedematous pancreatitis: not stated

Necrotising pancreatitis: not stated

Mild pancreatitis: 0 (0%)

Moderate pancreatitis: not stated

Severe pancreatitis: not stated

Persistent organ failure: not stated

Infected pancreatitis: not stated

Inclusion criteria: people with moderate or severe pancreatitis

Exclusion criteria

  1. < 18 years of age

  2. Women in whom pregnancy could not be excluded

  3. People with acute pancreatitis following pregnancy

Interventions

Group 1: octreotide (n = 28), 1 mg/day IV for 5 days
Group 2: placebo (n = 30)

Outcomes

Mortality, serious adverse events, adverse events, organ failure, infected pancreatic necrosis, hospital stay

Follow‐up: not stated (probably until discharge)

Notes

—

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Quote: "[r]andomization was by the use of sequentially numbered treatment packs containing either octreotide or placebo as determined by a computer‐generated random code."

Allocation concealment (selection bias)

Low risk

Quote: "[r]andomization was by the use of sequentially numbered treatment packs containing either octreotide or placebo as determined by a computer‐generated random code."

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "[p]atients, investigators, and medical staff were blinded regarding the nature of the trial infusion".

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "[p]atients, investigators, and medical staff were blinded regarding the nature of the trial infusion".

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Comment: there were no postrandomisation dropouts.

Selective reporting (reporting bias)

Low risk

Comment: mortality and adverse events were reported.

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Low risk

Comment: no other risk of bias
McKay 1997b

Methods

Randomised clinical trial

Participants

Country: UK

Number randomised: 51

Postrandomisation dropouts: 1 (2%)

Revised sample size: 50

Average age: 65 years

Women: 21 (42%)

Acute interstitial oedematous pancreatitis: not stated

Necrotising pancreatitis: not stated

Mild pancreatitis: not stated

Moderate pancreatitis: not stated

Severe pancreatitis: not stated

Persistent organ failure: not stated

Infected pancreatitis: not stated

Inclusion criteria: people with predicted severe pancreatitis

Exclusion criteria

  1. Pregnancy

  2. ERCP induced pancreatitis

  3. Oral anticoagulant use

  4. Other trial drugs within 3 months of study

  5. Previous use of lexipafant

Interventions

Group 1: lexipafant (n = 26), 4 mg bolus IV followed by 4 mg/h by continuous infusion for 5‐7 days
Group 2: placebo (n = 24)

Outcomes

Mortality, organ failure, hospital stay

Follow‐up: not stated (probably until discharge)

Notes

Reasons for postrandomisation dropouts: incorrect diagnosis

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Low risk

Quote: "[p]acks were numbered sequentially and prepared in advance by British Biotech (Oxford, UK)".

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "[i]nvestigators and patients were unaware of the nature of the trial infusion."

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "[i]nvestigators and patients were unaware of the nature of the trial infusion."

Incomplete outcome data (attrition bias)
All outcomes

High risk

Comment: there were postrandomisation dropouts.

Selective reporting (reporting bias)

High risk

Comment: either mortality or adverse events were not reported.

For profit‐bias

High risk

Quote: "[t]his study was supported by a grant from British Biotech".

Other bias

Low risk

Comment: no other risk of bias
Moreau 1986

Methods

Randomised clinical trial

Participants

Country: France

Number randomised: 87

Postrandomisation dropouts: 3 (3.4%)

Revised sample size: 84

Average age: not stated

Women: not stated

Acute interstitial oedematous pancreatitis: not stated

Necrotising pancreatitis: not stated

Mild pancreatitis: not stated

Moderate pancreatitis: not stated

Severe pancreatitis: not stated

Persistent organ failure: not stated

Infected pancreatitis: not stated

Inclusion criteria: people with acute pancreatitis

Exclusion criteria

  1. Acute pancreatitis following surgery or ERCP

  2. Duration of symptoms for more than 48 h

Interventions

Group 1: somatostatin (n = 44), 400 μg for first 3 days, tapered and stopped on 4th day
Group 2: placebo (n = 41)

Outcomes

None of the outcomes of interest were reported.

Follow‐up: not stated (probably until discharge)

Notes

Reasons for postrandomisation dropouts: not stated

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "double‐blind"

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "double‐blind"

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Comment: this information was not available.

Selective reporting (reporting bias)

High risk

Comment: either mortality or adverse events were not reported.

For profit‐bias

High risk

Quote: "Sonafi, kindly donated"

Other bias

Low risk

Comment: no other risk of bias
MRC Multicentre Trial 1977

Methods

Randomised clinical trial

Participants

Country: UK
Number randomised: 264
Postrandomisation dropouts: 7 (2.7%)
Revised sample size: 257
Average age: not stated
Women: 153 (59.5%)
Acute interstitial oedematous pancreatitis: not stated
Necrotising pancreatitis: not stated
Mild pancreatitis: not stated
Moderate pancreatitis: not stated
Severe pancreatitis: not stated
Persistent organ failure: not stated
Infected pancreatitis: not stated
Inclusion criteria: people with acute pancreatitis

Interventions

Group 1: aprotinin (n = 66), 500,000 IU IV followed by 300,000 units every 6 h for 5 days
Group 2: glucagon (n = 68), 2 mg IV followed by 2 mg every 6 h for 5 days
Group 3: placebo (n = 123)

Outcomes

Mortality, requirement for surgery

Follow‐up: not stated (probably until discharge)

Notes

Reasons for postrandomisation dropouts: initial amylase was too low

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "[r]andomized, double‐blind, placebo‐controlled, multi‐centre trial across 15 centres in India"

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "[r]andomized, double‐blind, placebo‐controlled, multi‐centre trial across 15 centres in India"

Incomplete outcome data (attrition bias)
All outcomes

High risk

Comment: there were postrandomisation dropouts.

Selective reporting (reporting bias)

High risk

Comment: either mortality or adverse events were not reported.

For profit‐bias

High risk

Comment: the drugs and placebo were supplied by the pharmaceutical company.

Other bias

Low risk

Comment: no other risk of bias
Nordback 2001

Methods

Randomised clinical trial

Participants

Country: Finland

Number randomised: 90

Postrandomisation dropouts: 32 (35.6%)

Revised sample size: 58

Average age: 46 years

Women: 7 (12.1%)

Acute interstitial oedematous pancreatitis: 0 (0%)

Necrotising pancreatitis: 58 (100%)

Mild pancreatitis: 0 (0%)

Moderate pancreatitis: not stated

Severe pancreatitis: not stated

Persistent organ failure: 0 (0%)

Infected pancreatitis: not stated

Inclusion criteria: people with acute necrotising pancreatitis

Exclusion criteria

  1. People who had already been started on antibiotics

  2. Those admitted to intensive care unit with multiorgan failure

  3. Suspected to have a reaction to study drugs

Interventions

Group 1: antibiotics (n = 25): imipenem 1 g plus cilastatin IV 3 times daily; duration not stated
Group 2: placebo (n = 33)

Outcomes

Mortality, serious adverse events, adverse events, requirement for surgery, ICU stay

Follow‐up: not stated (probably until discharge)

Notes

Reasons for postrandomisation dropouts: older than 70 years of age, did not begin antibiotic as scheduled, criteria for pancreatic necrosis not fulfilled

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Comment: although a placebo was used, it was not clear blinding was performed.

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Comment: although a placebo was used, it was not clear blinding was performed.

Incomplete outcome data (attrition bias)
All outcomes

High risk

Comment: there were postrandomisation dropouts.

Selective reporting (reporting bias)

Low risk

Comment: mortality and adverse events were reported.

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Low risk

Comment: no other risk of bias
Ohair 1993

Methods

Randomised clinical trial

Participants

Country: USA
Number randomised: 180
Postrandomisation dropouts: not stated
Revised sample size: 180
Average age: 37 years
Women: 41 (22.8%)
Acute interstitial oedematous pancreatitis: not stated
Necrotising pancreatitis: not stated
Mild pancreatitis: not stated
Moderate pancreatitis: not stated
Severe pancreatitis: not stated
Persistent organ failure: not stated
Infected pancreatitis: not stated
Inclusion criteria: people with acute pancreatitis

Interventions

Group 1: octreotide (n = 90), 100 μg 3 times daily SC for duration of hospital stay
Group 2: placebo (n = 90)

Outcomes

Requirement for surgery, hospital stay

Follow‐up: not stated (probably until discharge)

Notes

Reasons for postrandomisation dropouts: not stated

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Comment: although a placebo was used, it was not clear blinding was performed.

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Comment: although a placebo was used, it was not clear blinding was performed.

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Comment: this information was not available.

Selective reporting (reporting bias)

High risk

Comment: either mortality or adverse events were not reported.

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Low risk

Comment: no other risk of bias
Olah 2007

Methods

Randomised clinical trial

Participants

Country: Hungary
Number randomised: 83
Postrandomisation dropouts: 21 (25.3%)
Revised sample size: 62
Average age: 47 years
Women: 10 (16.1%)
Acute interstitial oedematous pancreatitis: not stated
Necrotising pancreatitis: not stated
Mild pancreatitis: 0 (0%)
Moderate pancreatitis: 0 (0%)
Severe pancreatitis: 62 (100%)
Persistent organ failure: not stated
Infected pancreatitis: not stated
Inclusion criteria: people with severe acute pancreatitis
Exclusion criteria: people with acute exacerbation of chronic pancreatitis.

Interventions

Group 1: probiotics (n = 33): Synbiotic 2000 once daily for at least 1 week
Group 2: no intervention (n = 29)
Both groups received prebiotics (an intervention not of interest for this review).

Outcomes

Mortality, serious adverse events, adverse events, requirement for surgery, organ failure, sepsis, infected pancreatic necrosis, hospital stay

Follow‐up: not stated (probably until discharge)

Notes

Reasons for postrandomisation dropouts: because they were not severe acute pancreatitis after 48 h, did not tolerate jejunal feeding, participant removed the feeding tube

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "double blind"

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "double blind"

Incomplete outcome data (attrition bias)
All outcomes

High risk

Comment: there were postrandomisation dropouts.

Selective reporting (reporting bias)

High risk

Comment: either mortality or adverse events were not reported.

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Low risk

Comment: no other risk of bias
Paran 1995

Methods

Randomised clinical trial

Participants

Country: Israel
Number randomised: 51
Postrandomisation dropouts: 13 (25.5%)
Revised sample size: 38
Average age: 61 years
Women: 18 (47.4%)
Acute interstitial oedematous pancreatitis: not stated
Necrotising pancreatitis: not stated
Mild pancreatitis: not stated
Moderate pancreatitis: not stated
Severe pancreatitis: not stated
Persistent organ failure: not stated
Infected pancreatitis: not stated
Inclusion criteria: people with acute pancreatitis

Interventions

Group 1: octreotide (n = 19), 01. mg SC 3 times daily for 14 days
Group 2: no intervention (n = 19)

Outcomes

Mortality, serious adverse events, adverse events, sepsis, hospital stay

Follow‐up: not stated (probably until discharge)

Notes

Reasons for postrandomisation dropouts: failure to meet inclusion criteria, incomplete data, incorrect diagnosis

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Quote: "[a]s placebo vials were not available to us, the study was double blinded".

Blinding of outcome assessment (detection bias)
All outcomes

High risk

Quote: "[a]s placebo vials were not available to us, the study was double blinded".

Incomplete outcome data (attrition bias)
All outcomes

High risk

Comment: there were postrandomisation dropouts.

Selective reporting (reporting bias)

Low risk

Comment: mortality and adverse events were reported.

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Low risk

Comment: no other risk of bias
Pederzoli 1993a

Methods

Randomised clinical trial

Participants

Country: Italy
Number randomised: 74
Postrandomisation dropouts: not stated
Revised sample size: 74
Average age: 52 years
Women: 30 (40.5%)
Acute interstitial oedematous pancreatitis: 0 (0%)
Necrotising pancreatitis: 74 (100%)
Mild pancreatitis: not stated
Moderate pancreatitis: not stated
Severe pancreatitis: not stated
Persistent organ failure: not stated
Infected pancreatitis: not stated
Inclusion criteria: people with acute pancreatitis

Interventions

Group 1: antibiotics (n = 41): imipenem 0.5 g every 8 h for 2 weeks
Group 2: no intervention (n = 33)

Outcomes

Mortality, serious adverse events, adverse events, requirement for surgery, organ failure, infected pancreatic necrosis

Follow‐up: not stated (probably until discharge)

Notes

Reasons for postrandomisation dropouts: not stated

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Quote: "casual numbers table".

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Comment: this information was not available.

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Comment: this information was not available.

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Comment: there were no postrandomisation dropouts.

Selective reporting (reporting bias)

Low risk

Comment: mortality and adverse events were reported.

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Low risk

Comment: no other risk of bias
Pederzoli 1993b

Methods

Randomised clinical trial

Participants

Country: Italy
Number randomised: 199
Postrandomisation dropouts: 17 (8.5%)
Revised sample size: 182
Average age: 58 years
Women: 78 (42.9%)
Acute interstitial oedematous pancreatitis: 66 (36.3%)
Necrotising pancreatitis: 116 (63.7%)
Mild pancreatitis: 0 (0%)
Moderate pancreatitis: not stated
Severe pancreatitis: not stated
Persistent organ failure: not stated
Infected pancreatitis: not stated
Inclusion criteria: people with acute pancreatitis

Interventions

Group 1: gabexate mesilate (n = 91), 3 g/day for 7 days
Group 2: aprotinin (n = 91), 1,500,000 KIU/day for 7 days

Outcomes

Mortality, adverse events, requirement for surgery

Follow‐up: 3 months for mortality; all other complications ‐ 2 weeks

Notes

Reasons for postrandomisation dropouts: major protocol violations

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "double‐blind"

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "double‐blind"

Incomplete outcome data (attrition bias)
All outcomes

High risk

Comment: there were postrandomisation dropouts.

Selective reporting (reporting bias)

Low risk

Comment: mortality and adverse events were reported.

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Low risk

Comment: no other risk of bias
Perezdeoteyza 1980

Methods

Randomised clinical trial

Participants

Country: Spain

Number randomised: 40

Postrandomisation dropouts: not stated

Revised sample size: 40

Average age: 56 years

Women: 24 (60%)

Acute interstitial oedematous pancreatitis: not stated

Necrotising pancreatitis: not stated

Mild pancreatitis: not stated

Moderate pancreatitis: not stated

Severe pancreatitis: not stated

Persistent organ failure: not stated

Infected pancreatitis: not stated

Inclusion criteria: people with acute pancreatitis

Exclusion criteria

  1. Post‐traumatic pancreatitis

  2. Postsurgical pancreatitis

  3. Previous pancreatitic bouts

Interventions

Group 1: cimetidine (n = 20), 1200 mg IV for 4‐5 days followed by 1000 mg oral for 10 days
Group 2: placebo (n = 20)

Outcomes

Mortality

Follow‐up: not stated (probably until discharge)

Notes

Reasons for postrandomisation dropouts: not stated

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Low risk

Quote: "[r]andomisation code was held by pharmacy"

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "double‐blind"

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "double‐blind"

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Comment: this information was not available.

Selective reporting (reporting bias)

High risk

Comment: either mortality or adverse events were not reported.

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Low risk

Comment: no other risk of bias
Pettila 2010

Methods

Randomised clinical trial

Participants

Country: Finland

Number randomised: 32

Postrandomisation dropouts: 0 (0%)

Revised sample size: 32

Average age: 45 years

Women: 3 (9.4%)

Acute interstitial oedematous pancreatitis: not stated

Necrotising pancreatitis: not stated

Mild pancreatitis: 0 (0%)

Moderate pancreatitis: 0 (0%)

Severe pancreatitis: 32 (100%)

Persistent organ failure: not stated

Infected pancreatitis: not stated

Inclusion criteria

  1. People with acute severe pancreatitis

  2. Admitted to hospital < 4 days of onset of pain

  3. At least one organ dysfunction

  4. < 48 h from the first organ dysfunction

Interventions

Group 1: activated protein C (n = 16): drotrecogin alpha activated 24 μg/kg/h for 96 h
Group 2: placebo (n = 16)

Outcomes

Mortality, hospital stay

Follow‐up: not stated (probably 2 weeks)

Notes

—

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Low risk

Quote: "[t]he code for study medication was concealed using sealed envelopes."

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "double‐blind"

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "double‐blind"

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Comment: there were no postrandomisation dropouts.

Selective reporting (reporting bias)

High risk

Comment: either mortality or adverse events were not reported.

For profit‐bias

High risk

Quote: "Eli Lilly in part provided the study drug for this investigator‐initiated study".

Other bias

Low risk

Comment: no other risk of bias
Plaudis 2010

Methods

Randomised clinical trial

Participants

Country: Latvia
Number randomised: 90
Postrandomisation dropouts: not stated
Revised sample size: 58
Average age: not stated
Women: not stated
Acute interstitial oedematous pancreatitis: not stated
Necrotising pancreatitis: not stated
Mild pancreatitis: not stated
Moderate pancreatitis: not stated
Severe pancreatitis: 58 (100%)
Persistent organ failure: not stated
Infected pancreatitis: not stated
Inclusion criteria: people with acute severe pancreatitis

Interventions

Group 1: probiotics (n = 30): 4 bioactive lactic acid bacteria
Group 2: no intervention (n = 28)
Both groups received prebiotics (an intervention not of interest for this review)

Outcomes

None of the outcomes of interest were reported.

Follow‐up: not stated (probably until discharge)

Notes

Reasons for postrandomisation dropouts: not stated

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "double blind"

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "double blind"

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Comment: this information was not available.

Selective reporting (reporting bias)

High risk

Comment: either mortality or adverse events were not reported.

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Low risk

Comment: no other risk of bias
Poropat 2015

Methods

Randomised clinical trial

Participants

Country: Croatia

Number randomised: 43

Postrandomisation dropouts: 0 (0%)

Revised sample size: 43

Average age: not stated

Women: not stated

Acute interstitial oedematous pancreatitis: not stated

Necrotising pancreatitis: not stated

Mild pancreatitis: not stated

Moderate pancreatitis: not stated

Severe pancreatitis: not stated

Persistent organ failure: not stated

Infected pancreatitis: not stated

Inclusion criteria

  1. People with acute pancreatitis

  2. APACHE II score ≥ 8

Interventions

Group 1: antibiotics (n = 23): imipenem 500 mg IV 3 times daily for 10 days
Group 2: no intervention (n = 24)

Outcomes

Mortality, serious adverse events, adverse events, infected pancreatic necrosis, and organ failure

Follow‐up: not stated (probably until discharge)

Notes

—

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Comment: this information was not available.

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Comment: this information was not available.

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Comment: there were no postrandomisation dropouts.

Selective reporting (reporting bias)

Low risk

Comment: mortality and adverse events were reported.

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Low risk

Comment: no other risk of bias
Rokke 2007

Methods

Randomised clinical trial

Participants

Country: Norway

Number randomised: 73

Postrandomisation dropouts: 0 (0%)

Revised sample size: 73

Average age: 58 years

Women: 24 (32.9%)

Acute interstitial oedematous pancreatitis: 0 (0%)

Necrotising pancreatitis: 73 (100%)

Mild pancreatitis: 0 (0%)

Moderate pancreatitis: 0 (0%)

Severe pancreatitis: 73 (100%)

Persistent organ failure: not stated

Infected pancreatitis: not stated

Inclusion criteria

  1. People with acute necrotising pancreatitis

  2. Duration of symptoms < 72 h

Exclusion criteria

  1. Age < 18 years

  2. Ongoing antibiotic treatment

  3. Previous episodes of acute pancreatitis

  4. Post‐ERCP pancreatitis

  5. Concomitant bacterial infection

  6. Allergy to imipenem

  7. Pregnancy

Interventions

Group 1: antibiotics (n = 36): imipenem 0.5 g every 8 h for 5‐7 days
Group 2: no intervention (n = 37)

Outcomes

Mortality, adverse events, requirement for surgery, organ failure, infected pancreatic necrosis, hospital stay, ICU stay

Follow‐up: not stated (probably 2 weeks)

Notes

—

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Quote: "[t]he study was unblinded to all attending physicians".

Blinding of outcome assessment (detection bias)
All outcomes

High risk

Quote: "[t]he study was unblinded to all attending physicians".

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Comment: there were no postrandomisation dropouts.

Selective reporting (reporting bias)

Low risk

Comment: mortality and adverse events were reported.

For profit‐bias

High risk

Quote: "[w]e are grateful to the pharmaceutical company MSD for economic support in organizing meetings for the Steering Committee".

Other bias

Low risk

Comment: no other risk of bias
Sainio 1995

Methods

Randomised clinical trial

Participants

Country: Finland

Number randomised: 60

Postrandomisation dropouts: 0 (0%)

Revised sample size: 60

Average age: 41 years

Women: 7 (11.7%)

Acute interstitial oedematous pancreatitis: 0 (0%)

Necrotising pancreatitis: 60 (100%)

Mild pancreatitis: 0 (0%)

Moderate pancreatitis: not stated

Severe pancreatitis: not stated

Persistent organ failure: not stated

Infected pancreatitis: not stated

Inclusion criteria: people with alcohol‐induced necrotising pancreatitis

Exclusion criteria

  1. Treatment elsewhere for more than 48 h of onset of symptoms

  2. Continuing antimicrobial treatment

  3. Previous severe episode of pancreatitis

  4. Aetiology other than alcohol and no history of alcohol intake prior to admission

Interventions

Group 1: antibiotics (n = 30): cefuroxime 1.5 g IV 3 times daily continued until clinical recovery and fall to normal level of C‐reactive protein, after which oral administration of 250 mg twice daily until 14 days
Group 2: no intervention (n = 30)

Outcomes

Mortality, serious adverse events, adverse events, requirement for surgery, sepsis, hospital stay, ICU stay

Follow‐up: not stated (probably until discharge)

Notes

—

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Comment: this information was not available.

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Comment: this information was not available.

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Comment: there were no postrandomisation dropouts.

Selective reporting (reporting bias)

Low risk

Comment: mortality and adverse events were reported.

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Low risk

Comment: no other risk of bias
Sateesh 2009

Methods

Randomised clinical trial

Participants

Country: India

Number randomised: 56

Postrandomisation dropouts: 3 (5.4%)

Revised sample size: 53

Average age: 39 years

Women: 33 (62.3%)

Acute interstitial oedematous pancreatitis: not stated

Necrotising pancreatitis: not stated

Mild pancreatitis: not stated

Moderate pancreatitis: not stated

Severe pancreatitis: 10 (18.9%)

Persistent organ failure: not stated

Infected pancreatitis: not stated

Inclusion criteria

  1. People with acute pancreatitis

  2. < 72 h of onset of symptoms

Exclusion criteria

  1. Acute exacerbation of chronic pancreatitis

  2. Prior antioxidant therapy

  3. Delayed presentation to the ward

  4. Severe comorbidity

  5. Pregnancy

Interventions

Group 1: antioxidants (n = 23): vitamin C 500 mg once daily, N‐acteyl cysteine 200 mg 3 times daily, Antoxyl Forte 1 capsule 3 times daily); duration not stated
Group 2: no intervention (n = 30)

Outcomes

Mortality, adverse events, organ failure, hospital stay

Follow‐up: not stated (probably until discharge)

Notes

Reasons for postrandomisation dropouts: did not receive allocated treatment, discontinued medication

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Quote: "according to a computer generated random number table"

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Quote: "[t]he study was unblinded".

Blinding of outcome assessment (detection bias)
All outcomes

High risk

Quote: "[t]he study was unblinded".

Incomplete outcome data (attrition bias)
All outcomes

High risk

Comment: there were postrandomisation dropouts.

Selective reporting (reporting bias)

Low risk

Comment: mortality and adverse events were reported.

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Low risk

Comment: no other risk of bias
Sharma 2011

Methods

Randomised clinical trial

Participants

Country: India

Number randomised: 50

Postrandomisation dropouts: 0 (0%)

Revised sample size: 50

Average age: 41 years

Women: 27 (54%)

Acute interstitial oedematous pancreatitis: not stated

Necrotising pancreatitis: not stated

Mild pancreatitis: 28 (56%)

Moderate pancreatitis: not stated

Severe pancreatitis: 22 (44%)

Persistent organ failure: not stated

Infected pancreatitis: not stated

Inclusion criteria

  1. People with acute pancreatitis

  2. < 72 h of onset of symptoms or had not been taking anything orally for up to 5 days

Exclusion criteria

  1. Malignancy

  2. Infection or sepsis related to source other than pancreatic bed

  3. Intra‐oeprative diagnosis of acute pancreatitis

  4. Immunodeficiency

  5. Earlier use of probiotics or prebiotics

  6. Pregnant women

Interventions

Group 1: probiotics (n = 24): 2.5 billion bacteria per sachet and 25 mg of fructo‐oligosaccharide every day for 7 days
Group 2: placebo (n = 26)

Outcomes

Hospital stay, ICU stay

Follow‐up: not stated (probably until discharge)

Notes

—

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Unclear risk

Quote: "[t]he method of allocation concealment was sequentially numbered sealed opaque envelopes technique".

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "double‐blind"

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "double‐blind"

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Comment: there were no postrandomisation dropouts.

Selective reporting (reporting bias)

High risk

Comment: either mortality or adverse events were not reported.

For profit‐bias

High risk

Quote: "[t]he authors disclose that Alkem provided the probiotics and placebo on complimentary basis."

Other bias

Low risk

Comment: no other risk of bias
Sillero 1981

Methods

Randomised clinical trial

Participants

Country: Spain
Number randomised: 60
Postrandomisation dropouts: not stated
Revised sample size: 60
Average age: 52 years
Women: 36 (60%)
Acute interstitial oedematous pancreatitis: not stated
Necrotising pancreatitis: not stated
Mild pancreatitis: not stated
Moderate pancreatitis: not stated
Severe pancreatitis: not stated
Persistent organ failure: not stated
Infected pancreatitis: not stated
Inclusion criteria: people with acute pancreatitis

Interventions

Group 1: cimetidine (n = 30): 1200 mg IV for 4 days followed by 1000 mg oral for 10 days
Group 2: placebo (n = 30)

Outcomes

Serious adverse events, adverse events, requirement for surgery

Follow‐up: not stated (probably until discharge)

Notes

Reasons for postrandomisation dropouts: not stated

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Quote: "table of random numbers"

Allocation concealment (selection bias)

Low risk

Quote: "sealed envelopes"

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Comment: although a placebo was used, it was not clear blinding was performed.

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Comment: although a placebo was used, it was not clear blinding was performed.

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Comment: this information was not available.

Selective reporting (reporting bias)

High risk

Comment: either mortality or adverse events were not reported.

For profit‐bias

Unclear risk

Comment: this information was not available

Other bias

Low risk

Comment: no other risk of bias
Siriwardena 2007

Methods

Randomised clinical trial

Participants

Country: UK

Number randomised: 43

Postrandomisation dropouts: 0 (0%)

Revised sample size: 43

Average age: 67 years

Women: 28 (65.1%)

Acute interstitial oedematous pancreatitis: not stated

Necrotising pancreatitis: not stated

Mild pancreatitis: not stated

Moderate pancreatitis: not stated

Severe pancreatitis: not stated

Persistent organ failure: not stated

Infected pancreatitis: not stated

Inclusion criteria

  1. People with predicted severe pancreatitis

  2. Within 72 h of admission to hospital

  3. 16 years of older

  4. Not enrolled in other trials

  5. No history of allergy to intravenous antioxidant therapy

  6. Enrolled in the trial with a previous episode of pancreatitis

Interventions

Group 1: antioxidants (n = 22) selenium started with 1000 mg and then tapered to 200 mg/day for a total duration of 7 days; vitamin C started with 2000 mg and then tapered to 1000 mg/day for a total duration of 7 days; N‐acetyl cysteine started with 300 mg and then tapered to 75 mg/day for a total duration of 7 days
Group 2: placebo (n = 21)

Outcomes

Mortality, serious adverse events, organ failure, hospital stay, ICU stay

Follow‐up: until discharge

Notes

—

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Quote: "random number generation"
Comment: probably computer‐generated

Allocation concealment (selection bias)

Low risk

Quote: "[t]he pharmacy administered the randomisation and storage of therapeutics for all participating centres".

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "double blind"

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "double blind"

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Comment: there were no postrandomisation dropouts.

Selective reporting (reporting bias)

Unclear risk

Comment: mortality and adverse events were reported.

For profit‐bias

High risk

Quote: "the costs of antioxidants and placebo were met by Pharmanord UK".

Other bias

Low risk

Comment: no other risk of bias
Spicak 2002

Methods

Randomised clinical trial

Participants

Country: Czech Republic

Number randomised: 63

Postrandomisation dropouts: not stated

Revised sample size: 63

Average age: 55 years

Women: 25 (39.7%)

Acute interstitial oedematous pancreatitis: not stated

Necrotising pancreatitis: not stated

Mild pancreatitis: 0 (0%)

Moderate pancreatitis: 0 (0%)

Severe pancreatitis: 63 (100%)

Persistent organ failure: not stated

Infected pancreatitis: not stated

Inclusion criteria

  1. People with severe acute pancreatitis

  2. Within 4 days of onset of symptoms

Exclusion criteria

  1. < 18 years of age

  2. More than 48 h from onset of symptoms

  3. Iatrogenic pancreatitis

  4. Infectious complications

  5. Already receiving antibiotics for previous 2 weeks

Interventions

Group 1: antibiotics (n = 33): metronidazole 500 mg 3 times daily and ciprofloxacin 200 mg twice daily for 2 weeks
Group 2: no intervention (n = 30)

Outcomes

Mortality, serious adverse events, adverse events, requirement for surgery, infected pancreatic necrosis, hospital stay, ICU stay

Follow‐up: not stated (probably until discharge)

Notes

Reasons for postrandomisation dropouts: not stated

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Comment: this information was not available.

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Comment: this information was not available.

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Comment: this information was not available.

Selective reporting (reporting bias)

Low risk

Comment: mortality and adverse events were reported.

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Low risk

Comment: no other risk of bias
Spicak 2003

Methods

Randomised clinical trial

Participants

Country: Czech Republic

Number randomised: 41

Postrandomisation dropouts: not stated

Revised sample size: 41

Average age: 58 years

Women: 10 (24.4%)

Acute interstitial oedematous pancreatitis: not stated

Necrotising pancreatitis: not stated

Mild pancreatitis: 0 (0%).

Moderate pancreatitis: 0 (0%)

Severe pancreatitis: 41 (100%)

Persistent organ failure: not stated

Infected pancreatitis: not stated

Inclusion criteria: people with acute pancreatitis

Exclusion criteria

  1. < 18 years of age

  2. More than 48 h from onset of symptoms

  3. Pancreatitis following surgery or ERCP

  4. Infectious complications

  5. Already receiving antibiotics for previous 2 weeks

Interventions

Group 1: antibiotics (n = 20): meropenem 0.5 mg 3 times daily for 10 days
Group 2: no intervention (n = 21)

Outcomes

Mortality, serious adverse events, adverse events, requirement for surgery, infected pancreatic necrosis, hospital stay

Follow‐up: not stated

Notes

Reasons for postrandomisation dropouts: not stated

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

This information was not available.

Allocation concealment (selection bias)

Unclear risk

This information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

This information was not available.

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

This information was not available.

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

This information was not available.

Selective reporting (reporting bias)

Low risk

Comment: mortality and adverse events were reported.

For profit‐bias

Unclear risk

This information was not available.

Other bias

Low risk

Comment: no other risk of bias
Storck 1968

Methods

Randomised clinical trial

Participants

Country: Sweden
Number randomised: 43
Postrandomisation dropouts: not stated
Revised sample size: 43
Average age: 59 years
Women: 28 (65.1%)
Acute interstitial oedematous pancreatitis: not stated
Necrotising pancreatitis: not stated
Mild pancreatitis: not stated
Moderate pancreatitis: not stated
Severe pancreatitis: not stated
Persistent organ failure: not stated
Infected pancreatitis: not stated
Inclusion criteria: people with acute pancreatitis

Interventions

Group 1: aprotinin (n = 21), first half of the trial ‐ 50,000 to 100,000 units per day and then dose doubled for an average of 12 days
Group 2: placebo (n = 22)

Outcomes

Mortality

Follow‐up: not stated (probably until discharge)

Notes

Reasons for postrandomisation dropouts: not stated

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Low risk

Quote: "[s]ealed envelopes"

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "double blind"

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "double blind"

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Comment: this information was not available.

Selective reporting (reporting bias)

High risk

Comment: either mortality or adverse events were not reported.

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Low risk

Comment: no other risk of bias
Trapnell 1974

Methods

Randomised clinical trial

Participants

Country: UK

Number randomised: 105

Postrandomisation dropouts: not stated

Revised sample size: 105

Average age: not stated

Women: not stated

Acute interstitial oedematous pancreatitis: not stated

Necrotising pancreatitis: not stated

Mild pancreatitis: not stated

Moderate pancreatitis: not stated

Severe pancreatitis: not stated

Persistent organ failure: not stated

Infected pancreatitis: not stated

Inclusion criteria

  1. People with first attack of acute pancreatitis

  2. Aetiology: gallstones or idiopathic pancreatitis

Interventions

Group 1: aprotinin (n = 53), 200,000 units IV stat followed by 200,000 units IV 4 times daily for 5 days
Group 2: placebo (n = 52)

Outcomes

Mortality

Follow‐up: not stated (probably until discharge)

Notes

Reasons for postrandomisation dropouts: not stated

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Quote: "random numbers"

Allocation concealment (selection bias)

Low risk

Quote: "[t]he envelopes of allotment were placed in a recognized position in each hospital together with the packs of Trasylol".

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "double blind"

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "double blind"

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Comment: this information was not available.

Selective reporting (reporting bias)

High risk

Comment: either mortality or adverse events were not reported.

For profit‐bias

High risk

Quote: "[w]e are particularly indebted to Dr Brian Allen of Bayer Pharmaceuticals for the supplies of Trasylol and the preparation of the A and B ampoules".

Other bias

Unclear risk

Comment: no other risk of bias
Tykka 1985

Methods

Randomised clinical trial

Participants

Country: Finland

Number randomised: 64

Postrandomisation dropouts: 0 (0%)

Revised sample size: 64

Average age: 51 years

Women: 23 (35.9%)

Acute interstitial oedematous pancreatitis: not stated

Necrotising pancreatitis: not stated

Mild pancreatitis: not stated

Moderate pancreatitis: not stated

Severe pancreatitis: not stated

Persistent organ failure: not stated

Infected pancreatitis: not stated

Inclusion criteria: people with acute pancreatitis

Exclusion criteria

  1. Post‐traumatic pancreatitis

  2. Postsurgical pancreatitis

Interventions

Group 1: EDTA (n = 33), dose and duration not reported
Group 2: placebo (n = 31)

Follow‐up: not stated (probably until discharge)

Outcomes

Mortality, serious adverse events, adverse events, requirement for surgery

Notes

—

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "double blind"

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "double blind"

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Comment: there were no postrandomisation dropouts.

Selective reporting (reporting bias)

Low risk

Comment: mortality and adverse events were reported.

For profit‐bias

High risk

Quote: "[w]e are also grateful for the drugs and support from Sinclair Pharmaceutical Limited, England."
Comment: this information was not available.

Other bias

Low risk

Comment: no other risk of bias
Uhl 1999

Methods

Randomised clinical trial

Participants

Country: Germany

Number randomised: 302

Postrandomisation dropouts: 0 (0%)

Revised sample size: 302

Average age: 50 years

Women: 104 (34.4%)

Acute interstitial oedematous pancreatitis: not stated

Necrotising pancreatitis: 108 (35.8%)

Mild pancreatitis: not stated

Moderate pancreatitis: not stated

Severe pancreatitis: not stated

Persistent organ failure: not stated

Infected pancreatitis: not stated

Inclusion criteria

  1. People with moderate to severe acute pancreatitis

  2. Duration of symptoms < 4 days

Exclusion criteria

  1. Known chronic renal failure

  2. < 18 years of age

  3. Pregnancy

  4. Psychosis (except alcoholic delirium)

  5. Previous treatment with aprotinin, glucagon, calcitonin, pirenzepine, atropine, or native somatostatin

  6. Previous included in the study (i.e. relapse after previous inclusion in the study)

Interventions

Group 1: octreotide (n = 199), 100 μg or 200 μg (randomised) SC 3 times daily for 7 days
Group 2: placebo (n = 103)

Outcomes

Mortality, serious adverse events, adverse events, requirement for surgery, sepsis, hospital stay

Follow‐up: not stated (probably until discharge)

Notes

—

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Low risk

Quote: "[t]he packages were used sequentially as the patients were enrolled in the study".

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "double blind"

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "double blind"

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Comment: there were no postrandomisation dropouts.

Selective reporting (reporting bias)

Low risk

Comment: mortality and adverse events were reported.

For profit‐bias

High risk

Quote: "[t]he preparation, randomisation, and delivery of the study medication, as well as the monitoring of the study centres by checking the information in the CRFs, were carried out by Novartis (formerly Sandoz), Nuremberg (Germany)".

Other bias

Low risk

Comment: no other risk of bias
Usadel 1985

Methods

Randomised clinical trial

Participants

Country: Germany
Number randomised: 77
Postrandomisation dropouts: not stated
Revised sample size: 77
Average age: not stated
Women: not stated
Acute interstitial oedematous pancreatitis: not stated
Necrotising pancreatitis: not stated
Mild pancreatitis: not stated
Moderate pancreatitis: not stated
Severe pancreatitis: not stated
Persistent organ failure: not stated
Infected pancreatitis: not stated
Inclusion criteria: people with acute pancreatitis

Interventions

Group 1: somatostain (n = 36), 250 ng/h for 7 days
Group 2: placebo (n = 41)

Outcomes

Mortality

Follow‐up: not stated (probably until discharge)

Notes

Reasons for postrandomisation dropouts: not stated

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "double blind"

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "double blind"

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Comment: this information was not available.

Selective reporting (reporting bias)

High risk

Comment: either mortality or adverse events were not reported.

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Low risk

Comment: no other risk of bias
Valderrama 1992

Methods

Randomised clinical trial

Participants

Country: Spain
Number randomised: 105
Postrandomisation dropouts: 5 (4.8%)
Revised sample size: 100
Average age: 57 years
Women: 53 (53%)
Acute interstitial oedematous pancreatitis: not stated
Necrotising pancreatitis: not stated
Mild pancreatitis: not stated
Moderate pancreatitis: not stated
Severe pancreatitis: not stated
Persistent organ failure: not stated
Infected pancreatitis: not stated
Inclusion criteria: people with acute pancreatitis

Interventions

Group 1: gabexate mesilate (n = 51), 12 mg/kg/day continuous IV for 4‐12 days based on disappearance of abdominal pain or requirement for surgery
Group 2: placebo (n = 49)

Outcomes

Mortality, serious adverse events, adverse events, sepsis

Follow‐up: not stated (probably until discharge)

Notes

Reasons for postrandomisation dropouts: protocol violations

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Quote: "computer generated"

Allocation concealment (selection bias)

Low risk

Quote: "consecutively numbered boxes containing FOY or placebo"

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "double blind"

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "double blind"

Incomplete outcome data (attrition bias)
All outcomes

High risk

Comment: there were postrandomisation dropouts.

Selective reporting (reporting bias)

Low risk

Comment: mortality and adverse events were reported.

For profit‐bias

High risk

Quote: "[t]he authors thank Laboratorio Dr Esteve SA for supplies of gabexate mesylate (FOY)".

Other bias

Low risk

Comment: no other risk of bias
Vege 2015

Methods

Randomised clinical trial

Participants

Country: USA

Number randomised: 28

Postrandomisation dropouts: not stated

Revised sample size: 28

Average age: not stated

Women: not stated

Acute interstitial oedematous pancreatitis: not stated

Necrotising pancreatitis: not stated

Mild pancreatitis: not stated

Moderate pancreatitis: not stated

Severe pancreatitis: not stated

Persistent organ failure: not stated

Infected pancreatitis: not stated

Inclusion criteria

  1. People with predicted severe acute pancreatitis

  2. < 72 h of onset of symptoms

Interventions

Group 1: antioxidant (n = 14): pentoxifylline 400 mg oral 3 times daily for 3 days
Group 2: placebo (n = 14)

Outcomes

Mortality, serious adverse events, organ failure, hospital stay, ICU stay

Follow‐up: not stated (probably until discharge)

Notes

Reasons for postrandomisation dropouts: not stated

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "double blind"

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "double blind"

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Comment: there were no postrandomisation dropouts.

Selective reporting (reporting bias)

Low risk

Comment: mortality and adverse events were reported.

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Low risk

Comment: no other risk of bias
Wang 2011

Methods

Randomised clinical trial

Participants

Country: China
Number randomised: 24
Postrandomisation dropouts: not stated
Revised sample size: 24
Average age: 46 years
Women: 15 (62.5%)
Acute interstitial oedematous pancreatitis: not stated
Necrotising pancreatitis: not stated
Mild pancreatitis: not stated
Moderate pancreatitis: not stated
Severe pancreatitis: 24 (100%).
Persistent organ failure: not stated
Infected pancreatitis: not stated
Inclusion criteria: people with severe acute pancreatitis.

Interventions

Group 1: thymosin alpha (n = 12), 3.2 mg twice daily for 7 days
Group 2: placebo (n = 12)

Outcomes

Mortality, hospital stay, ICU stay

Follow‐up: 1 month

Notes

Reasons for postrandomisation dropouts: not stated

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "double blind"

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "double blind"

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Comment: this information was not available.

Selective reporting (reporting bias)

High risk

Comment: either mortality or adverse events were not reported.

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Low risk

Comment: no other risk of bias
Wang 2013a

Methods

Randomised clinical trial

Participants

Country: China

Number randomised: 183

Postrandomisation dropouts: not stated

Revised sample size: 183

Average age: 42 years

Women: 89 (48.6%)

Acute interstitial oedematous pancreatitis: not stated

Necrotising pancreatitis: not stated

Mild pancreatitis: not stated

Moderate pancreatitis: not stated

Severe pancreatitis: 159 (86.9%)

Persistent organ failure: not stated

Infected pancreatitis: not stated

Inclusion criteria

  1. People with severe acute pancreatitis

  2. Age: 18 to 45 years

  3. < 2 days from onset of symptoms

  4. Presence of gastrointestinal ileus or distension

Exclusion criteria

  1. History of renal dysfunction

  2. Pregnant or lactating

  3. Expected to receive extracorporeal removal

  4. Inflammatory bowel disease

  5. Infections at the time of hospital admission

  6. Received recent NSAID

Interventions

Group 1: somatostatin plus ulinastatin (n = 62)
Group 2: somatostatin (n = 61)
Group 3: no intervention (n = 60)
Somatostatin: 250 μg/h IV for 10 days.
Ulinastatin: 10,000 units IV twice daily for 10 days

Outcomes

Mortality, serious adverse events

Follow‐up: not stated (probably until discharge)

Notes

Reasons for postrandomisation dropouts: not stated

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "double blind"

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "double blind"

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Comment: this information was not available.

Selective reporting (reporting bias)

Low risk

Comment: mortality and adverse events were reported.

For profit‐bias

Low risk

Quote: "[t]he authors have no direct relationship with any of the companies mentioned in this article, either by employment or by receiving research grants".

Other bias

Low risk

Comment: no other risk of bias
Wang 2013b

Methods

Randomised clinical trial

Participants

Country: China
Number randomised: 354
Postrandomisation dropouts: not stated
Revised sample size: 354
Average age: not stated
Women: not stated
Acute interstitial oedematous pancreatitis: not stated
Necrotising pancreatitis: not stated
Mild pancreatitis: not stated
Moderate pancreatitis: not stated
Severe pancreatitis: not stated
Persistent organ failure: not stated
Infected pancreatitis: not stated
Inclusion criteria: people with predicted severe acute pancreatitis

Interventions

Group 1: octreotide plus NSAID (n = not reported)
Group 2: octreotide (n = not reported)
Octreotide: 50 μg/h for first 3 days followed by 25 μg/h for next 4 days
NSAID: celecoxib 200 mg twice daily for 7 days

Outcomes

None of the outcomes of interest were reported.

Follow‐up: not stated (probably until discharge)

Notes

Reasons for postrandomisation dropouts: not stated

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Comment: this information was not available.

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Comment: this information was not available.

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Comment: this information was not available.

Selective reporting (reporting bias)

High risk

Comment: either mortality or adverse events were not reported.

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Low risk

Comment: no other risk of bias
Wang 2013c

Methods

Randomised clinical trial

Participants

Country: China

Number randomised: 372

Postrandomisation dropouts: not stated

Revised sample size: 372

Average age: 45 years

Women: 174 (46.8%)

Acute interstitial oedematous pancreatitis: not stated

Necrotising pancreatitis: not stated

Mild pancreatitis: not stated

Moderate pancreatitis: not stated

Severe pancreatitis: 0 (0%)

Persistent organ failure: not stated

Infected pancreatitis: not stated

Inclusion criteria

  1. People with predicted severe acute pancreatitis or acute pancreatitis

  2. Age 18 to 70 years

  3. Admission in < 48 h of onset of symptoms

  4. No other severe diseases such as cirrhosis, chronic obstructive airway disease, chronic renal insufficiency, malignant tumours

Exclusion criteria: people with alcohol dependence

Interventions

Group 1: octreotide (n = 157), 50 μg/h for first 3 days followed by 25 μg/h for next 4 days or 25 μg/h for 7 days (randomised)
Group 2: no intervention (n = 79)

Outcomes

Mortality, serious adverse events, adverse events, requirement for surgery, requirement for endoscopic or radiological drainage, organ failure, hospital stay

Follow‐up: some outcomes were measured on 8th day and others at 1 month

Notes

Reasons for postrandomisation dropouts: not stated

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Quote: "computer‐generated randomization numbers"

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Quote: "[t]he physicians and nurses who managed the patients were blinded so that they did not know the patient has been allocated to and what treatment they had received".
Comment: there is no mention of participant blinding.

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "[t]he physicians and nurses who managed the patients were blinded so that they did not know the patient has been allocated to and what treatment they had received".

Incomplete outcome data (attrition bias)
All outcomes

High risk

Comment: there were postrandomisation dropouts.

Selective reporting (reporting bias)

Low risk

Comment: mortality and adverse events were reported.

For profit‐bias

Low risk

Quote: "[t]his study was supported by a Key Grant #30330270 from the Natural Science Fund of China and the National Ministry of Health Fund for the Public Welfare 2‐13".

Other bias

Low risk

Comment: no other risk of bias
Wang 2016

Methods

Randomised clinical trial

Participants

Country: China

Number randomised: 492

Postrandomisation dropouts: not stated

Revised sample size: 492

Average age: 41 years

Women: 238 (48.4%)

Acute interstitial oedematous pancreatitis: not stated

Necrotising pancreatitis: not stated

Mild pancreatitis: 0 (0%)

Moderate pancreatitis: 0 (0%)

Severe pancreatitis: 492 (100%)

Persistent organ failure: not stated

Infected pancreatitis: not stated

Inclusion criteria: people with severe acute pancreatitis

Exclusion criteria

  1. Evidence or a known history of renal dysfunction

  2. Pregnancy

  3. Malignancy

  4. Immunodeficiency

  5. Pre‐existing chronic kidney diseases requiring regular hemodialysis

Interventions

Group 1: somatostatin plus ulinastatin plus gabexate (n = 116)
Group 2: somatostatin plus ulinastatin (n = 124)
Group 3: somatostatin plus gabexate (n = 130)
Group 4: somatostatin (n = 122)
Somatostatin: 3 mg IV for 10 days
Ulinastatin: 10,000 units IV twice daily for 10 days
Gabexate: 0.1 g IV 3 times daily for 10 days

Outcomes

Mortality, adverse events, organ failure, length of hospital stay

Follow‐up: not stated (probably until discharge)

Notes

—

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Quote: "[a]ccording to a computerized random number generation . . ."

Allocation concealment (selection bias)

Low risk

Quote: "sealed envelopes"

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "[t]his was a prospective and double‐blind study"
Comment: a placebo was used to achieve blinding.

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "[t]his was a prospective and double‐blind study"
Comment: a placebo was used to achieve blinding.

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Comment: there were no postrandomisation dropouts.

Selective reporting (reporting bias)

Low risk

Comment: mortality and adverse events were reported.

For profit‐bias

Low risk

Quote: "[t]his work was supported by National Natural Science Foundation of China, China (81360080, 81071594) and the Science Foundation of Science and Technology Hall of Jiangxi Province, China (20091391308000)."

Other bias

Low risk

Comment: no other risk of bias
Xia 2014

Methods

Randomised clinical trial

Participants

Country: China

Number randomised: 140

Postrandomisation dropouts: not stated

Revised sample size: 140

Average age: 43 years

Women: 48 (34.3%)

Acute interstitial oedematous pancreatitis: not stated

Necrotising pancreatitis: not stated

Mild pancreatitis: not stated

Moderate pancreatitis: not stated

Severe pancreatitis: 140 (100%)

Persistent organ failure: not stated

Infected pancreatitis: not stated

Inclusion criteria

  1. People with severe acute pancreatitis

  2. No associated severe liver disease or biliary diseases

  3. Pancreatitis not resulting from trauma, malignancy

  4. No contraindications or allergies to somatostatin

  5. No treatment with other drugs which could affect the results of this study

Interventions

Group 1: somatostatin (3 mg IV twice daily for 7 days) plus omeprazole (40 mg IV twice daily for 7 days) (n = 70)
Group 2: no intervention (n = 70)

Outcomes

Mortality, serious adverse events, adverse events

Follow‐up: not stated (probably until discharge)

Notes

Reasons for postrandomisation dropouts: not stated

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Comment: this information was not available.

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Comment: this information was not available.

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Comment: this information was not available.

Selective reporting (reporting bias)

Low risk

Comment: mortality and adverse events were reported.

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Low risk

Comment: no other risk of bias
Xue 2009

Methods

Randomised clinical trial

Participants

Country: China

Number randomised: 59

Postrandomisation dropouts: 3 (5.1%)

Revised sample size: 56

Average age: 48 years

Women: 28 (50%)

Acute interstitial oedematous pancreatitis: 0 (0%)

Necrotising pancreatitis: 56 (100%)

Mild pancreatitis: 0 (0%)

Moderate pancreatitis: 0 (0%)

Severe pancreatitis: 56 (100%)

Persistent organ failure: not stated

Infected pancreatitis: 0

Inclusion criteria

  1. People with acute necrotising pancreatitis and identified as severe acute pancreatitis

  2. Within 3 days of onset of symptoms

  3. Age at least 18 years

Exclusion criteria

  1. Concurrent sepsis or peripancreatic infection

  2. Direct transfer to ICU for multiorgan failure

  3. Pancreatitis secondary to trauma, ERCP, or operation

  4. Recurrent pancreatitis

  5. Pregnancy, malignancy, or immunodeficiency

  6. History of antibiotic administration within 48 h prior to enrolment

  7. Possible death within 48 h after enrolment

Interventions

Group 1: antibiotics (n = 29): imipenem‐cilastatin 0.5 g every 8 h for 7‐14 days
Group 2: no intervention (n = 27)

Outcomes

Mortality, serious adverse events, adverse events, requirement for surgery, hospital stay

Follow‐up: 1 month

Notes

Reasons for postrandomisation dropouts: death after starting treatment, transferred to operation

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Quote: "computer‐derived random number sequence"

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Comment: this information was not available.

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Comment: this information was not available.

Incomplete outcome data (attrition bias)
All outcomes

High risk

Comment: there were postrandomisation dropouts.

Selective reporting (reporting bias)

Low risk

Comment: mortality and adverse events were reported.

For profit‐bias

Low risk

Quote: "[w]e thank Sichuan Province Science and Technology Tackling Key Project (no. 05SG011‐021‐1) for providing financial support for the trial and the publication of the paper".

Other bias

Low risk

Comment: no other risk of bias
Yang 1999

Methods

Randomised clinical trial

Participants

Country: China
Number randomised: 48
Postrandomisation dropouts: not stated
Revised sample size: 48
Average age: 45 years
Women: 26 (54.2%)
Acute interstitial oedematous pancreatitis: not stated
Necrotising pancreatitis: not stated
Mild pancreatitis: not stated
Moderate pancreatitis: not stated
Severe pancreatitis: not stated
Persistent organ failure: not stated
Infected pancreatitis: not stated
Inclusion criteria: people with acute pancreatitis

Interventions

Group 1: somatostatin (n = 25), 250 μg/h for 3‐4 days
Group 2: no intervention (n = 23)

Outcomes

Serious adverse events, adverse events

Follow‐up: not stated (probably until discharge)

Notes

Reasons for postrandomisation dropouts: not stated

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Comment: this information was not available.

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Comment: this information was not available.

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Comment: this information was not available.

Selective reporting (reporting bias)

High risk

Comment: either mortality or adverse events were not reported.

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Low risk

Comment: no other risk of bias
Yang 2012

Methods

Randomised clinical trial

Participants

Country: China

Number randomised: 163

Postrandomisation dropouts: 6 (3.7%)

Revised sample size: 157

Average age: 46 years

Women: 71 (45.2%)

Acute interstitial oedematous pancreatitis: not stated

Necrotising pancreatitis: not stated

Mild pancreatitis: 157 (100%)

Moderate pancreatitis: not stated

Severe pancreatitis: not stated

Persistent organ failure: not stated

Infected pancreatitis: not stated

Inclusion criteria

  1. People with mild pancreatitis

  2. Aged between 18 and 70 years

  3. < 48 h of symptoms

  4. People with a BMI > 25 kg/m²

Exclusion criteria

  1. People with alcohol dependence

  2. Pregnancy

  3. Drug abuse

  4. Psychosis

  5. Cirrhosis

  6. Chronic obstructive pulmonary disease

  7. Chronic renal insufficiency

  8. Malignancy

Interventions

Group 1: octreotide (n = 80), 50 μg/h for 3 days
Group 2: no intervention (n = 77)

Outcomes

Mortality, hospital stay

Follow‐up: 1 month

Notes

Reasons for postrandomisation dropouts: loss to follow‐up; lack of data

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Quote: "computer‐generated randomization numbers"

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Comment: this information was not available.

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Comment: this information was not available.

Incomplete outcome data (attrition bias)
All outcomes

High risk

Comment: there were postrandomisation dropouts.

Selective reporting (reporting bias)

High risk

Comment: either mortality or adverse events were not reported.

For profit‐bias

Low risk

Quote: "[t]his study was supported by Key Grant #30330270 of the Natural Science Fund of China and the National Ministry of Health Fund for Public Welfare 2‐13."

Other bias

Low risk

Comment: no other risk of bias
Zhu 2014

Methods

Randomised clinical trial

Participants

Country: China

Number randomised: 39

Postrandomisation dropouts: not stated

Revised sample size: 39

Average age: 43 years

Women: 18 (46.2%)

Acute interstitial oedematous pancreatitis: not stated

Necrotising pancreatitis: not stated

Mild pancreatitis: 0 (0%)

Moderate pancreatitis: 0 (0%)

Severe pancreatitis: 39 (100%)

Persistent organ failure: not stated

Infected pancreatitis: not stated

Inclusion criteria

  1. People with severe acute pancreatitis

  2. < 48 h from onset of symptoms

  3. < 65 years of age

Exclusion criteria

  1. Chronic pancreatitis

  2. Associated with primary infection, tumours, low immunity

Interventions

Group 1: probiotics (n = 20), 2 tablets twice daily for 14 days (Japanese preparation)
Group 2: placebo (n = 19)

Outcomes

Serious adverse events, adverse events, requirement for endoscopic or radiological drainage, infected pancreatic necrosis

Follow‐up: not stated (probably 2 weeks)

Notes

Reasons for postrandomisation dropouts: not stated

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Comment: this information was not available.

Allocation concealment (selection bias)

Unclear risk

Comment: this information was not available.

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "double‐blind"

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "double‐blind"

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Comment: this information was not available.

Selective reporting (reporting bias)

High risk

Comment: either mortality or adverse events were not reported.

For profit‐bias

Unclear risk

Comment: this information was not available.

Other bias

Low risk

Comment: no other risk of bias

ERCP: endoscopic retrograde cholangiopancreatography; ICU: intensive care unit; IU: international unit; IV: intravenous; KIU: kallikrein inhibitor units; MRC: Medical Research Council (1 MRC = 1 IU); PR: per rectum; SC: subcutaneous.

Characteristics of excluded studies [ordered by study ID]

Ir a:

Study

Reason for exclusion

Akzhigitov 1968

Not an RCT

Akzhigitov 1969

Not an RCT

Al‐Leswas 2013a

Comparison of 2 different antioxidants

Al‐Leswas 2013b

Comparison of 2 different antioxidants

Al‐Leswas 2013c

Comparison of 2 different antioxidants

Al‐Leswas 2013d

Comparison of 2 different antioxidants

Al‐Leswas 2013e

Comparison of 2 different antioxidants

Al‐Leswas 2013f

Comparison of 2 different antioxidants

Al‐Leswas 2013g

Comparison of 2 different antioxidants

Amundsen 1972

Not conducted in humans

Andersson 2008

Not a primary research study (commentary)

Baden 1967

Quasi‐RCT (allocation based on birth date) comparing 2 different preparations of aprotinin

Baden 1969

Quasi‐RCT (allocation based on birth date) comparing 2 different preparations of aprotinin

Bai 2013

Not an RCT

Bassi 1998

Comparison of 2 different antibiotic regimens

Beechey‐Newman 1991

Not an RCT

Beechey‐Newman 1993

Not an RCT

Beger 2001

Not a primary research study (commentary)

Bender 1992

Not an RCT

Binder 1993

Comparison of different doses of octreotide

Binder 1994

Comparison of different doses of octreotide

Brown 2004

Not a primary research study (editorial)

Buchler 1988

Not an RCT

Cameron 1979

Quasi‐randomised study (allocation by patient number)

Cheng 2008

There was no control group for pharmacological intervention

Cullimore 2008

Not a primary research study (letter to editor)

Curtis 1997

Not a primary research study (review)

D'Amico 1990

Not an RCT

Da Silvereira 2002

Not a primary research study (commentary)

De Vries 2007

Not a primary research study (systematic review)

Dikkenberg 2008

Not a primary research study (commentary)

Dreiling 1977

Not an RCT

Du 2002

Comparison of 2 doses of vitamin C

Du 2003

Comparison of 2 doses of vitamin C

Dürr 1985

Quasi‐RCT (allocation by alternation)

Freise 1985

Not an RCT

Friess 1994

Not a primary research study (review)

Gabryelewicz 1968

Not in humans

Gabryelewicz 1976

Not an RCT

Gao 2015b

Not a pharmacological intervention

Garcia 2005

Comparison of 2 variations of probiotics

Gostishchev 1977

Not a primary research study (review)

Guo 2013

Comparison of different doses of octreotide

Hajdu 2012

Variations in nutritional supplementation

Harinath 2002

Prophylactic intervention (not in people with acute pancreatitis)

Hart 2008

Not a primary research study (review)

He 2004

Not a pharmacological intervention

Helton 2001

Not a primary research study (comment)

Hoekstra 2008

Not a primary research study (letter to editor)

Holub 1974

Not a primary research study (letter to editor)

Howard 2007

Not a primary research study (editorial)

Howes 1975

Quasi‐RCT (allocation by hospital number)

Huang 2008

Variations in different types of nutritional supplementation

Issekutz 2002

No suitable control (3 groups were: probiotics + fibre versus inactivated lactobacilli + fibre versus standard nutrition; it is not possible to obtain the effect estimate of probiotics alone from this comparison)

Ivanov 2002

Not an RCT

Jiang 1988

Not an RCT

Karakan 2007

Not a pharmacological intervention (fibre supplementation only)

Karakoyunlar 1999

Not an RCT

Karavanov 1966

Not an RCT

Lasztity 2005a

Variations in fatty acids used in enteral nutrition

Lasztity 2005b

Variations in fatty acids used in enteral nutrition

Lasztity 2006

Variations in fatty acids used in enteral nutrition

Lata 1998

Not an RCT

Lata 2010

This started as a RCT but was converted to a cohort study after publication of negative results

Lim 2015

Not a primary research study (review)

Lu 2006

Not a pharmacological intervention (variations in parenteral nutrition)

Lu 2008

Intervention includes a non‐pharmacological treatment in addition to antioxidant

Manes 2003

Comparison of 2 different antibiotics

Manes 2006

Comparison of 2 different antibiotic regimens

McClave 2009

Not a primary research study (editorial)

Mercadier 1973

Not an RCT

Niu 2014

Comparison of 2 different fats

Pearce 2006

Variations in composition of enteral feeds

Pederzoli 1995

Not primary research (review)

Pezzilli 1997

Comparison of two doses of gabexate mesilate

Pezzilli 1999

Comparison of 2 doses of gabexate mesilate

Pezzilli 2001

Comparison of 2 doses of gabexate mesilate

Piascik 2010

In addition to the difference in the groups in terms of whether the patients received protease inhibitor, the antibiotic regimen differed between the groups

Plaudis 2012

Not an RCT

Rahman 2003

Not a primary research study (letter to editor)

Ranson 1976

Not an RCT

Reddy 2008

Not a primary research study (letter to editor)

Santen 2008

Not primary research (letter to editor)

Singer 1966

No mention about randomisation

Skyring 1965

No mention about randomisation

Tanaka 1979

There were 2 trials reported in this publication. Of these, 1 was a quasi‐RCT (alternate allocation) and it was not clear whether the second trial was an RCT

Tang 2005

Only the control group received Chinese medicines

Tang 2007

Not an RCT

Ukai 2015

Not a primary research study (review)

Usadel 1980

Not a primary research study (letter to editor)

Venkatesan 2008

Not a primary research study (commentary)

Villatoro 2010

Not primary research (review)

Wang 2008

Variations in composition of parenteral nutrition

Wang 2009

Variations in composition of parenteral nutrition

Weismann 2010

Not a primary research study (commentary)

Wyncoll 1998

Not a primary research study (letter to editor)

Xiong 2009

Variations in parenteral nutrition

Xu 2012

Variations in parenteral nutrition

Yang 2008a

Not an RCT

Yang 2008b

Variations in total parenteral nutrition

Yang 2009

Chinese medicines were given to the control group but not the intervention group

Zapater 2000

The co‐interventions in the groups varied apart from the drug being evaluated (nasogastric suction was used only in the control group)

RCT = randomised controlled trial

Characteristics of studies awaiting assessment [ordered by study ID]

Ir a:

Hansen 1966

Methods

Awaiting full text

Participants

—

Interventions

—

Outcomes

—

Notes

—
Perez 1980

Methods

Awaiting full text

Participants

—

Interventions

—

Outcomes

—

Notes

—

Characteristics of ongoing studies [ordered by study ID]

Ir a:

ChiCTR‐IPR‐16008301

Trial name or title

The effect of proton pump inhibitors on acute pancreatitis‐‐a randomly prospective control study

Methods

Randomised controlled trial

Participants

Adults with acute pancreatitis

Interventions

Proton pump inhibitor (omeprazole) versus placebo

Outcomes

Duration of hospital stay, gastrointestinal bleeding, and hospital costs

Starting date

September 2016

Contact information

Xiao Ma ([email protected])

Notes

—
EUCTR2014‐004844‐37‐ES

Trial name or title

Trial of indomethacin in pancreatitis

Methods

Randomised controlled trial

Participants

Adults with acute pancreatitis

Interventions

Non‐steroidal anti‐inflammatory drugs (indomethacin) versus placebo

Outcomes

Mortality and organ failure

Starting date

May 2015

Contact information

Enrique de Madaria Pascual ([email protected])

Notes

ChiCTR‐IPR‐16008301, NCT02692391
NCT01132521

Trial name or title

Ulinastatin in severe acute pancreatitis

Methods

Randomised controlled trial

Participants

Adults with severe acute pancreatitis

Interventions

Ulinastatin versus placebo

Outcomes

mortality, organ failure, requirement for additional invasive intervention, hospital stay, intensive care unit stay

Starting date

June 2010

Contact information

Chunyou Wang (Wuhan Union Hospital, China)

Notes

The study is currently suspended.
NCT02025049

Trial name or title

DP‐b99 in the treatment of acute high‐risk pancreatitis

Methods

Randomised controlled trial

Participants

Adults with predicted severe acute pancreatitis

Interventions

DP‐b99 versus placebo

Outcomes

Complications

Starting date

December 2013

Contact information

Gilad Rosenberg (Wuhan Union Hospital, China)

Notes

The University Hospital Brno, Gastroenterology Clinic, Brno, Czech Republic, 62500
NCT02212392

Trial name or title

Comparing the outcome in patients of acute pancreatitis, with and without prophylactic antibiotics

Methods

Randomised controlled trial

Participants

Adults with acute pancreatitis

Interventions

Antibiotics (meropenem) versus no intervention

Outcomes

Infections and hospital stay

Starting date

Jan 2013

Contact information

Fazal H Shah (Benazir Bhutto Hospital, Rawalpindi, Punjab, Pakistan, 46000)

Notes

—
NCT02692391

Trial name or title

A randomized controlled pilot trial of indomethacin in acute pancreatitis

Methods

Randomised controlled trial

Participants

Adults with acute pancreatitis

Interventions

Non‐steroidal anti‐inflammatory drugs (indomethacin) versus placebo

Outcomes

Mortality and organ failure

Starting date

April 2014

Contact information

Georgios I Papachristou ([email protected])

Notes

—
NCT02885441

Trial name or title

Treatment of acute pancreatitis with ketorolac

Methods

Randomised controlled trial

Participants

Adults with predicted severe acute pancreatitis

Interventions

Non‐steroidal anti‐inflammatory drugs (ketorolac) versus placebo

Outcomes

New onset organ failure, pancreatic necrosis, and duration of hospital stay

Starting date

September 2016

Contact information

Shaahin Shahbazi ([email protected])

Notes

—

Data and analyses

Open in table viewer
Comparison 1. Acute pancreatitis

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Short‐term mortality Show forest plot

67

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only
Analysis 1.1
Comparison 1 Acute pancreatitis, Outcome 1 Short‐term mortality.

Comparison 1 Acute pancreatitis, Outcome 1 Short‐term mortality.

1.1 Antibiotics versus control

17

1058

Odds Ratio (M‐H, Fixed, 95% CI)

0.81 [0.57, 1.15]

1.2 Antioxidants versus control

4

163

Odds Ratio (M‐H, Fixed, 95% CI)

2.01 [0.53, 7.56]

1.3 Aprotinin versus control

7

651

Odds Ratio (M‐H, Fixed, 95% CI)

0.68 [0.40, 1.14]

1.4 Calcitonin versus control

2

125

Odds Ratio (M‐H, Fixed, 95% CI)

0.55 [0.15, 2.00]

1.5 Cimetidine versus control

1

40

Odds Ratio (M‐H, Fixed, 95% CI)

1.0 [0.06, 17.18]

1.6 EDTA versus control

1

64

Odds Ratio (M‐H, Fixed, 95% CI)

0.94 [0.12, 7.08]

1.7 Gabexate versus control

5

576

Odds Ratio (M‐H, Fixed, 95% CI)

0.79 [0.48, 1.30]

1.8 Glucagon versus control

5

409

Odds Ratio (M‐H, Fixed, 95% CI)

0.97 [0.51, 1.87]

1.9 Iniprol versus control

1

24

Odds Ratio (M‐H, Fixed, 95% CI)

0.14 [0.01, 1.67]

1.10 Lexipafant versus control

3

423

Odds Ratio (M‐H, Fixed, 95% CI)

0.55 [0.30, 1.01]

1.11 Octreotide versus control

5

927

Odds Ratio (M‐H, Fixed, 95% CI)

0.76 [0.47, 1.23]

1.12 Probiotics versus control

2

358

Odds Ratio (M‐H, Fixed, 95% CI)

1.70 [0.87, 3.30]

1.13 Activated protein C versus control

1

32

Odds Ratio (M‐H, Fixed, 95% CI)

8.56 [0.41, 180.52]

1.14 Somatostatin versus control

6

493

Odds Ratio (M‐H, Fixed, 95% CI)

0.57 [0.29, 1.10]

1.15 Somatostatin plus omeprazole versus control

1

140

Odds Ratio (M‐H, Fixed, 95% CI)

0.23 [0.05, 1.11]

1.16 Somatostatin plus ulinastatin versus control

1

122

Odds Ratio (M‐H, Fixed, 95% CI)

0.43 [0.15, 1.23]

1.17 Thymosin versus control

1

24

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.18 Ulinastatin versus control

1

132

Odds Ratio (M‐H, Fixed, 95% CI)

0.45 [0.12, 1.72]

1.19 Gabexate versus aprotinin

2

298

Odds Ratio (M‐H, Fixed, 95% CI)

0.62 [0.32, 1.20]

1.20 Glucagon versus aprotinin

1

134

Odds Ratio (M‐H, Fixed, 95% CI)

1.33 [0.44, 4.08]

1.21 Glucagon versus atropine

1

150

Odds Ratio (M‐H, Fixed, 95% CI)

4.17 [0.45, 38.21]

1.22 Octreotide plus ulinastatin versus octreotide

1

120

Odds Ratio (M‐H, Fixed, 95% CI)

0.31 [0.06, 1.60]

1.23 Somatostatin plus gabexate versus somatostatin

1

252

Odds Ratio (M‐H, Fixed, 95% CI)

0.93 [0.37, 2.33]

1.24 Somatostatin plus ulinastatin versus somatostatin

2

369

Odds Ratio (M‐H, Fixed, 95% CI)

0.73 [0.34, 1.56]

1.25 Somatostatin plus ulinastatin plus gabexate versus somatostatin

1

238

Odds Ratio (M‐H, Fixed, 95% CI)

0.61 [0.21, 1.74]

1.26 Somatostatin plus ulinastatin versus somatostatin plus gabexate

1

254

Odds Ratio (M‐H, Fixed, 95% CI)

0.72 [0.26, 1.95]

1.27 Somatostatin plus ulinastatin plus gabexate versus somatostatin plus gabexate

1

246

Odds Ratio (M‐H, Fixed, 95% CI)

0.65 [0.23, 1.86]

1.28 Somatostatin plus ulinastatin plus gabexate versus somatostatin plus ulinastatin

1

240

Odds Ratio (M‐H, Fixed, 95% CI)

0.91 [0.30, 2.80]

2 Serious adverse events (proportion) Show forest plot

17

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only
Analysis 1.2
Comparison 1 Acute pancreatitis, Outcome 2 Serious adverse events (proportion).

Comparison 1 Acute pancreatitis, Outcome 2 Serious adverse events (proportion).

2.1 Antibiotics versus control

5

304

Odds Ratio (M‐H, Fixed, 95% CI)

0.65 [0.37, 1.15]

2.2 Antioxidants versus control

2

82

Odds Ratio (M‐H, Fixed, 95% CI)

1.98 [0.48, 8.13]

2.3 EDTA versus control

1

64

Odds Ratio (M‐H, Fixed, 95% CI)

0.52 [0.11, 2.39]

2.4 Gabexate versus control

2

201

Odds Ratio (M‐H, Fixed, 95% CI)

1.31 [0.31, 5.60]

2.5 Glucagon versus control

2

127

Odds Ratio (M‐H, Fixed, 95% CI)

0.29 [0.01, 7.46]

2.6 Octreotide versus control

1

58

Odds Ratio (M‐H, Fixed, 95% CI)

1.73 [0.61, 4.93]

2.7 Somatostatin versus control

2

111

Odds Ratio (M‐H, Fixed, 95% CI)

1.07 [0.35, 3.27]

2.8 Gabexate versus aprotinin

1

116

Odds Ratio (M‐H, Fixed, 95% CI)

1.05 [0.22, 4.91]

2.9 Ulinastatin versus gabexate

1

62

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Serious adverse events (number) Show forest plot

37

Rate Ratio (Fixed, 95% CI)

Subtotals only
Analysis 1.3
Comparison 1 Acute pancreatitis, Outcome 3 Serious adverse events (number).

Comparison 1 Acute pancreatitis, Outcome 3 Serious adverse events (number).

3.1 Antibiotics versus control

12

716

Rate Ratio (Fixed, 95% CI)

0.86 [0.68, 1.07]

3.2 Antioxidants versus control

2

71

Rate Ratio (Fixed, 95% CI)

0.22 [0.02, 2.21]

3.3 Aprotinin versus control

3

264

Rate Ratio (Fixed, 95% CI)

0.79 [0.49, 1.29]

3.4 Cimetidine versus control

1

60

Rate Ratio (Fixed, 95% CI)

1.0 [0.20, 4.95]

3.5 EDTA versus control

1

64

Rate Ratio (Fixed, 95% CI)

0.94 [0.19, 4.65]

3.6 Gabexate versus control

3

375

Rate Ratio (Fixed, 95% CI)

0.86 [0.64, 1.15]

3.7 Glucagon versus control

1

68

Rate Ratio (Fixed, 95% CI)

1.0 [0.02, 50.40]

3.8 Lexipafant versus control

1

290

Rate Ratio (Fixed, 95% CI)

0.67 [0.46, 0.96]

3.9 Octreotide versus control

4

770

Rate Ratio (Fixed, 95% CI)

0.74 [0.60, 0.89]

3.10 Probiotics versus control

3

397

Rate Ratio (Fixed, 95% CI)

0.94 [0.65, 1.36]

3.11 Somatostatin versus control

3

257

Rate Ratio (Fixed, 95% CI)

1.03 [0.66, 1.59]

3.12 Somatostatin plus omeprazole versus control

1

140

Rate Ratio (Fixed, 95% CI)

0.36 [0.19, 0.70]

3.13 Somatostatin plus ulinastatin versus control

1

122

Rate Ratio (Fixed, 95% CI)

0.30 [0.15, 0.60]

3.14 Glucagon versus atropine

1

150

Rate Ratio (Fixed, 95% CI)

0.33 [0.03, 3.20]

3.15 Octreotide plus ulinastatin versus octreotide

1

120

Rate Ratio (Fixed, 95% CI)

0.30 [0.17, 0.51]

3.16 Somatostatin plus ulinastatin versus somatostatin

1

123

Rate Ratio (Fixed, 95% CI)

0.28 [0.15, 0.56]

4 Organ failure Show forest plot

18

Odds Ratio (M‐H, Random, 95% CI)

Subtotals only
Analysis 1.4
Comparison 1 Acute pancreatitis, Outcome 4 Organ failure.

Comparison 1 Acute pancreatitis, Outcome 4 Organ failure.

4.1 Antibiotics versus control

5

258

Odds Ratio (M‐H, Random, 95% CI)

0.78 [0.44, 1.38]

4.2 Antioxidants versus control

4

163

Odds Ratio (M‐H, Random, 95% CI)

0.92 [0.39, 2.12]

4.3 Gabexate versus control

1

50

Odds Ratio (M‐H, Random, 95% CI)

0.32 [0.01, 8.25]

4.4 Lexipafant versus control

2

340

Odds Ratio (M‐H, Random, 95% CI)

0.68 [0.36, 1.27]

4.5 Octreotide versus control

2

430

Odds Ratio (M‐H, Random, 95% CI)

0.51 [0.27, 0.97]

4.6 Probiotics versus control

2

358

Odds Ratio (M‐H, Random, 95% CI)

0.80 [0.26, 2.47]

4.7 Ulinastatin versus control

1

129

Odds Ratio (M‐H, Random, 95% CI)

0.27 [0.01, 6.67]

4.8 Somatostatin plus gabexate versus somatostatin

1

252

Odds Ratio (M‐H, Random, 95% CI)

0.78 [0.33, 1.80]

4.9 Somatostatin plus ulinastatin versus somatostatin

1

246

Odds Ratio (M‐H, Random, 95% CI)

0.58 [0.23, 1.45]

4.10 Somatostatin plus ulinastatin plus gabexate versus somatostatin

1

238

Odds Ratio (M‐H, Random, 95% CI)

0.46 [0.17, 1.25]

4.11 Somatostatin plus ulinastatin versus somatostatin plus gabexate

1

254

Odds Ratio (M‐H, Random, 95% CI)

0.75 [0.29, 1.92]

4.12 Somatostatin plus ulinastatin plus gabexate versus somatostatin plus gabexate

1

246

Odds Ratio (M‐H, Random, 95% CI)

0.59 [0.21, 1.65]

4.13 Somatostatin plus ulinastatin plus gabexate versus somatostatin plus ulinastatin

1

240

Odds Ratio (M‐H, Random, 95% CI)

0.79 [0.27, 2.35]

5 Infected pancreatic necrosis Show forest plot

15

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only
Analysis 1.5
Comparison 1 Acute pancreatitis, Outcome 5 Infected pancreatic necrosis.

Comparison 1 Acute pancreatitis, Outcome 5 Infected pancreatic necrosis.

5.1 Antibiotics versus control

11

714

Odds Ratio (M‐H, Fixed, 95% CI)

0.82 [0.53, 1.25]

5.2 Octreotide versus control

1

58

Odds Ratio (M‐H, Fixed, 95% CI)

0.52 [0.04, 6.06]

5.3 Probiotics versus control

3

397

Odds Ratio (M‐H, Fixed, 95% CI)

1.10 [0.62, 1.96]

6 Sepsis Show forest plot

11

Odds Ratio (M‐H, Random, 95% CI)

Subtotals only
Analysis 1.6
Comparison 1 Acute pancreatitis, Outcome 6 Sepsis.

Comparison 1 Acute pancreatitis, Outcome 6 Sepsis.

6.1 Antibiotics versus control

1

60

Odds Ratio (M‐H, Random, 95% CI)

0.42 [0.11, 1.60]

6.2 Aprotinin versus control

2

103

Odds Ratio (M‐H, Random, 95% CI)

1.84 [0.49, 6.96]

6.3 Gabexate versus control

3

373

Odds Ratio (M‐H, Random, 95% CI)

1.10 [0.55, 2.19]

6.4 Lexipafant versus control

1

290

Odds Ratio (M‐H, Random, 95% CI)

0.26 [0.08, 0.83]

6.5 Octreotide versus control

2

340

Odds Ratio (M‐H, Random, 95% CI)

0.40 [0.05, 3.53]

6.6 Probiotics versus control

1

62

Odds Ratio (M‐H, Random, 95% CI)

0.36 [0.10, 1.36]

6.7 Gabexate versus aprotinin

1

116

Odds Ratio (M‐H, Random, 95% CI)

1.05 [0.22, 4.91]

7 Adverse events (proportion) Show forest plot

27

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only
Analysis 1.7
Comparison 1 Acute pancreatitis, Outcome 7 Adverse events (proportion).

Comparison 1 Acute pancreatitis, Outcome 7 Adverse events (proportion).

7.1 Antibiotics versus control

6

429

Odds Ratio (M‐H, Fixed, 95% CI)

0.51 [0.32, 0.80]

7.2 Antioxidants versus control

1

39

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

7.3 Calcitonin versus control

1

94

Odds Ratio (M‐H, Fixed, 95% CI)

0.88 [0.12, 6.49]

7.4 EDTA versus control

1

64

Odds Ratio (M‐H, Fixed, 95% CI)

0.79 [0.27, 2.31]

7.5 Gabexate versus control

3

373

Odds Ratio (M‐H, Fixed, 95% CI)

0.83 [0.54, 1.27]

7.6 Glucagon versus control

2

127

Odds Ratio (M‐H, Fixed, 95% CI)

0.09 [0.00, 1.69]

7.7 Lexipafant versus control

1

83

Odds Ratio (M‐H, Fixed, 95% CI)

0.43 [0.16, 1.12]

7.8 Octreotide versus control

3

398

Odds Ratio (M‐H, Fixed, 95% CI)

1.00 [0.65, 1.55]

7.9 Probiotics versus control

1

62

Odds Ratio (M‐H, Fixed, 95% CI)

0.35 [0.12, 1.01]

7.10 Somatostatin versus control

2

111

Odds Ratio (M‐H, Fixed, 95% CI)

0.44 [0.19, 1.02]

7.11 Somatostatin plus omeprazole versus control

1

140

Odds Ratio (M‐H, Fixed, 95% CI)

0.00 [0.00, 0.04]

7.12 Gabexate versus aprotinin

2

298

Odds Ratio (M‐H, Fixed, 95% CI)

0.41 [0.23, 0.70]

7.13 Ulinastatin versus gabexate

1

62

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

7.14 Ulinastatin versus octreotide

1

25

Odds Ratio (M‐H, Fixed, 95% CI)

2.33 [0.46, 11.81]

7.15 Somatostatin plus gabexate versus somatostatin

1

252

Odds Ratio (M‐H, Fixed, 95% CI)

0.93 [0.44, 1.95]

7.16 Somatostatin plus ulinastatin versus somatostatin

1

246

Odds Ratio (M‐H, Fixed, 95% CI)

0.58 [0.25, 1.34]

7.17 Somatostatin plus ulinastatin plus gabexate versus somatostatin

1

238

Odds Ratio (M‐H, Fixed, 95% CI)

0.49 [0.20, 1.20]

7.18 Somatostatin plus ulinastatin versus somatostatin plus gabexate

1

254

Odds Ratio (M‐H, Fixed, 95% CI)

0.63 [0.27, 1.44]

7.19 Somatostatin plus ulinastatin plus gabexate versus somatostatin plus gabexate

1

246

Odds Ratio (M‐H, Fixed, 95% CI)

0.53 [0.22, 1.28]

7.20 Somatostatin plus ulinastatin plus gabexate versus somatostatin plus ulinastatin

1

240

Odds Ratio (M‐H, Fixed, 95% CI)

0.84 [0.32, 2.22]

8 Adverse events (number) Show forest plot

40

Rate Ratio (Random, 95% CI)

Subtotals only
Analysis 1.8
Comparison 1 Acute pancreatitis, Outcome 8 Adverse events (number).

Comparison 1 Acute pancreatitis, Outcome 8 Adverse events (number).

8.1 Antibiotics versus control

12

755

Rate Ratio (Random, 95% CI)

0.75 [0.58, 0.95]

8.2 Antioxidants versus control

2

94

Rate Ratio (Random, 95% CI)

0.82 [0.38, 1.79]

8.3 Aprotinin versus control

3

264

Rate Ratio (Random, 95% CI)

0.98 [0.69, 1.39]

8.4 Calcitonin versus control

1

94

Rate Ratio (Random, 95% CI)

0.88 [0.12, 6.25]

8.5 Cimetidine versus control

1

60

Rate Ratio (Random, 95% CI)

1.14 [0.64, 2.02]

8.6 EDTA versus control

1

64

Rate Ratio (Random, 95% CI)

0.63 [0.28, 1.39]

8.7 Gabexate versus control

3

375

Rate Ratio (Random, 95% CI)

0.76 [0.61, 0.95]

8.8 Glucagon versus control

2

90

Rate Ratio (Random, 95% CI)

1.19 [0.51, 2.80]

8.9 Lexipafant versus control

1

290

Rate Ratio (Random, 95% CI)

0.61 [0.44, 0.85]

8.10 Octreotide versus control

4

634

Rate Ratio (Random, 95% CI)

0.78 [0.58, 1.05]

8.11 Probiotics versus control

3

397

Rate Ratio (Random, 95% CI)

0.84 [0.52, 1.36]

8.12 Somatostatin versus control

2

134

Rate Ratio (Random, 95% CI)

0.75 [0.26, 2.18]

8.13 Ulinastatin versus control

1

129

Rate Ratio (Random, 95% CI)

0.69 [0.32, 1.46]

8.14 Gabexate versus aprotinin

1

182

Rate Ratio (Random, 95% CI)

0.66 [0.38, 1.14]

8.15 Glucagon versus atropine

1

150

Rate Ratio (Random, 95% CI)

0.79 [0.36, 1.73]

8.16 Oxyphenonium versus glucagon

1

62

Rate Ratio (Random, 95% CI)

0.93 [0.65, 1.34]

8.17 Octreotide plus ulinastatin versus octreotide

1

120

Rate Ratio (Random, 95% CI)

0.29 [0.17, 0.48]

9 Requirement for additional invasive intervention Show forest plot

32

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only
Analysis 1.9
Comparison 1 Acute pancreatitis, Outcome 9 Requirement for additional invasive intervention.

Comparison 1 Acute pancreatitis, Outcome 9 Requirement for additional invasive intervention.

9.1 Antibiotics versus control

14

884

Odds Ratio (M‐H, Fixed, 95% CI)

0.82 [0.59, 1.13]

9.2 Aprotinin versus control

2

237

Odds Ratio (M‐H, Fixed, 95% CI)

0.59 [0.23, 1.47]

9.3 Calcitonin versus control

2

125

Odds Ratio (M‐H, Fixed, 95% CI)

0.30 [0.08, 1.16]

9.4 Cimetidine versus control

1

60

Odds Ratio (M‐H, Fixed, 95% CI)

0.13 [0.01, 2.61]

9.5 EDTA versus control

1

64

Odds Ratio (M‐H, Fixed, 95% CI)

0.68 [0.14, 3.29]

9.6 Gabexate versus control

3

426

Odds Ratio (M‐H, Fixed, 95% CI)

0.58 [0.37, 0.90]

9.7 Glucagon versus control

2

260

Odds Ratio (M‐H, Fixed, 95% CI)

1.26 [0.58, 2.77]

9.8 Octreotide versus control

3

854

Odds Ratio (M‐H, Fixed, 95% CI)

0.76 [0.48, 1.21]

9.9 Probiotics versus control

2

358

Odds Ratio (M‐H, Fixed, 95% CI)

1.50 [0.83, 2.71]

9.10 Somatostatin versus control

1

100

Odds Ratio (M‐H, Fixed, 95% CI)

0.40 [0.11, 1.38]

9.11 Gabexate versus aprotinin

1

182

Odds Ratio (M‐H, Fixed, 95% CI)

0.5 [0.19, 1.32]

9.12 Glucagon versus aprotinin

1

134

Odds Ratio (M‐H, Fixed, 95% CI)

1.33 [0.44, 4.08]

9.13 Oxyphenonium versus glucagon

1

62

Odds Ratio (M‐H, Fixed, 95% CI)

1.0 [0.13, 7.59]

10 Endoscopic or radiological drainage of collections Show forest plot

3

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only
Analysis 1.10
Comparison 1 Acute pancreatitis, Outcome 10 Endoscopic or radiological drainage of collections.

Comparison 1 Acute pancreatitis, Outcome 10 Endoscopic or radiological drainage of collections.

10.1 Antibiotics versus control

1

23

Odds Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 9.07]

10.2 Octreotide versus control

1

372

Odds Ratio (M‐H, Fixed, 95% CI)

0.89 [0.40, 1.96]

10.3 Probiotics versus control

1

39

Odds Ratio (M‐H, Fixed, 95% CI)

0.94 [0.20, 4.44]
Open in table viewer
Comparison 2. Acute necrotising pancreatitis

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Short‐term mortality Show forest plot

11

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only
Analysis 2.1
Comparison 2 Acute necrotising pancreatitis, Outcome 1 Short‐term mortality.

Comparison 2 Acute necrotising pancreatitis, Outcome 1 Short‐term mortality.

1.1 Antibiotics versus control

10

683

Odds Ratio (M‐H, Fixed, 95% CI)

0.82 [0.52, 1.30]

1.2 Gabexate versus aprotinin

1

116

Odds Ratio (M‐H, Fixed, 95% CI)

0.52 [0.20, 1.36]

2 Serious adverse events (proportion) Show forest plot

5

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only
Analysis 2.2
Comparison 2 Acute necrotising pancreatitis, Outcome 2 Serious adverse events (proportion).

Comparison 2 Acute necrotising pancreatitis, Outcome 2 Serious adverse events (proportion).

2.1 Antibiotics versus control

4

281

Odds Ratio (M‐H, Fixed, 95% CI)

0.84 [0.46, 1.54]

2.2 Gabexate versus aprotinin

1

116

Odds Ratio (M‐H, Fixed, 95% CI)

1.05 [0.22, 4.91]

3 Serious adverse events (number) Show forest plot

7

Rate Ratio (Fixed, 95% CI)

Subtotals only
Analysis 2.3
Comparison 2 Acute necrotising pancreatitis, Outcome 3 Serious adverse events (number).

Comparison 2 Acute necrotising pancreatitis, Outcome 3 Serious adverse events (number).

3.1 Antibiotics versus control

7

Rate Ratio (Fixed, 95% CI)

0.79 [0.59, 1.06]

4 Organ failure Show forest plot

4

Odds Ratio (M‐H, Random, 95% CI)

Subtotals only
Analysis 2.4
Comparison 2 Acute necrotising pancreatitis, Outcome 4 Organ failure.

Comparison 2 Acute necrotising pancreatitis, Outcome 4 Organ failure.

4.1 Antibiotics versus control

4

211

Odds Ratio (M‐H, Random, 95% CI)

0.78 [0.42, 1.45]

5 Infected pancreatic necrosis Show forest plot

6

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only
Analysis 2.5
Comparison 2 Acute necrotising pancreatitis, Outcome 5 Infected pancreatic necrosis.

Comparison 2 Acute necrotising pancreatitis, Outcome 5 Infected pancreatic necrosis.

5.1 Antibiotics versus control

6

426

Odds Ratio (M‐H, Fixed, 95% CI)

0.85 [0.51, 1.42]

6 Sepsis Show forest plot

2

Odds Ratio (M‐H, Random, 95% CI)

Subtotals only
Analysis 2.6
Comparison 2 Acute necrotising pancreatitis, Outcome 6 Sepsis.

Comparison 2 Acute necrotising pancreatitis, Outcome 6 Sepsis.

6.1 Antibiotics versus control

1

60

Odds Ratio (M‐H, Random, 95% CI)

0.42 [0.11, 1.60]

6.2 Gabexate versus aprotinin

1

116

Odds Ratio (M‐H, Random, 95% CI)

1.05 [0.22, 4.91]
Open in table viewer
Comparison 3. Severe acute pancreatitis

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Short‐term mortality Show forest plot

22

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only
Analysis 3.1
Comparison 3 Severe acute pancreatitis, Outcome 1 Short‐term mortality.

Comparison 3 Severe acute pancreatitis, Outcome 1 Short‐term mortality.

1.1 Antibiotics versus control

9

542

Odds Ratio (M‐H, Fixed, 95% CI)

0.82 [0.53, 1.27]

1.2 Aprotinin versus control

2

103

Odds Ratio (M‐H, Fixed, 95% CI)

0.66 [0.19, 2.30]

1.3 Calcitonin versus control

1

31

Odds Ratio (M‐H, Fixed, 95% CI)

0.78 [0.11, 5.46]

1.4 Gabexate versus control

1

52

Odds Ratio (M‐H, Fixed, 95% CI)

0.19 [0.04, 0.99]

1.5 Probiotics versus control

1

62

Odds Ratio (M‐H, Fixed, 95% CI)

0.25 [0.05, 1.34]

1.6 Activated protein C versus control

1

32

Odds Ratio (M‐H, Fixed, 95% CI)

8.56 [0.41, 180.52]

1.7 Somatostatin versus control

2

182

Odds Ratio (M‐H, Fixed, 95% CI)

0.51 [0.21, 1.23]

1.8 Somatostatin plus omeprazole versus control

1

140

Odds Ratio (M‐H, Fixed, 95% CI)

0.23 [0.05, 1.11]

1.9 Somatostatin plus ulinastatin versus control

1

122

Odds Ratio (M‐H, Fixed, 95% CI)

0.43 [0.15, 1.23]

1.10 Thymosin versus control

1

24

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.11 Ulinastatin versus control

1

70

Odds Ratio (M‐H, Fixed, 95% CI)

0.24 [0.04, 1.29]

1.12 Octreotide plus ulinastatin versus octreotide

1

120

Odds Ratio (M‐H, Fixed, 95% CI)

0.31 [0.06, 1.60]

1.13 Somatostatin plus gabexate versus somatostatin

1

252

Odds Ratio (M‐H, Fixed, 95% CI)

0.93 [0.37, 2.33]

1.14 Somatostatin plus ulinastatin versus somatostatin

2

369

Odds Ratio (M‐H, Fixed, 95% CI)

0.73 [0.34, 1.56]

1.15 Somatostatin plus ulinastatin plus gabexate versus somatostatin

1

238

Odds Ratio (M‐H, Fixed, 95% CI)

0.61 [0.21, 1.74]

1.16 Somatostatin plus ulinastatin versus somatostatin plus gabexate

1

254

Odds Ratio (M‐H, Fixed, 95% CI)

0.72 [0.26, 1.95]

1.17 Somatostatin plus ulinastatin plus gabexate versus somatostatin plus gabexate

1

246

Odds Ratio (M‐H, Fixed, 95% CI)

0.65 [0.23, 1.86]

1.18 Somatostatin plus ulinastatin plus gabexate versus somatostatin plus ulinastatin

1

240

Odds Ratio (M‐H, Fixed, 95% CI)

0.91 [0.30, 2.80]

2 Serious adverse events (proportion) Show forest plot

3

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only
Analysis 3.2
Comparison 3 Severe acute pancreatitis, Outcome 2 Serious adverse events (proportion).

Comparison 3 Severe acute pancreatitis, Outcome 2 Serious adverse events (proportion).

2.1 Antibiotics versus control

3

164

Odds Ratio (M‐H, Fixed, 95% CI)

0.56 [0.27, 1.18]

3 Serious adverse events (number) Show forest plot

13

Rate Ratio (Random, 95% CI)

Subtotals only
Analysis 3.3
Comparison 3 Severe acute pancreatitis, Outcome 3 Serious adverse events (number).

Comparison 3 Severe acute pancreatitis, Outcome 3 Serious adverse events (number).

3.1 Antibiotics versus control

5

Rate Ratio (Random, 95% CI)

0.81 [0.52, 1.25]

3.2 Aprotinin versus control

2

Rate Ratio (Random, 95% CI)

0.65 [0.25, 1.71]

3.3 Gabexate versus control

1

Rate Ratio (Random, 95% CI)

0.64 [0.37, 1.10]

3.4 Probiotics versus control

2

Rate Ratio (Random, 95% CI)

0.62 [0.24, 1.59]

3.5 Somatostatin versus control

1

Rate Ratio (Random, 95% CI)

1.07 [0.67, 1.69]

3.6 Somatostatin plus omeprazole versus control

1

Rate Ratio (Random, 95% CI)

0.36 [0.19, 0.70]

3.7 Somatostatin plus ulinastatin versus control

1

Rate Ratio (Random, 95% CI)

0.30 [0.15, 0.60]

3.8 Octreotide plus ulinastatin versus octreotide

1

Rate Ratio (Random, 95% CI)

0.30 [0.17, 0.51]

3.9 Somatostatin plus ulinastatin versus somatostatin

1

Rate Ratio (Random, 95% CI)

0.28 [0.15, 0.56]

4 Organ failure Show forest plot

6

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only
Analysis 3.4
Comparison 3 Severe acute pancreatitis, Outcome 4 Organ failure.

Comparison 3 Severe acute pancreatitis, Outcome 4 Organ failure.

4.1 Antibiotics versus control

3

137

Odds Ratio (M‐H, Fixed, 95% CI)

0.89 [0.40, 1.99]

4.2 Lexipafant versus control

0

0

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.3 Probiotics versus control

1

62

Odds Ratio (M‐H, Fixed, 95% CI)

0.40 [0.12, 1.36]

4.4 Ulinastatin versus control

1

67

Odds Ratio (M‐H, Fixed, 95% CI)

0.05 [0.01, 0.21]

4.5 Somatostatin plus gabexate versus somatostatin

1

252

Odds Ratio (M‐H, Fixed, 95% CI)

0.78 [0.33, 1.80]

4.6 Somatostatin plus ulinastatin versus somatostatin

1

246

Odds Ratio (M‐H, Fixed, 95% CI)

0.58 [0.23, 1.45]

4.7 Somatostatin plus ulinastatin plus gabexate versus somatostatin

1

238

Odds Ratio (M‐H, Fixed, 95% CI)

0.46 [0.17, 1.25]

4.8 Somatostatin plus ulinastatin versus somatostatin plus gabexate

1

254

Odds Ratio (M‐H, Fixed, 95% CI)

0.75 [0.29, 1.92]

4.9 Somatostatin plus ulinastatin plus gabexate versus somatostatin plus gabexate

1

246

Odds Ratio (M‐H, Fixed, 95% CI)

0.59 [0.21, 1.65]

4.10 Somatostatin plus ulinastatin plus gabexate versus somatostatin plus ulinastatin

1

240

Odds Ratio (M‐H, Fixed, 95% CI)

0.79 [0.27, 2.35]

5 Infected pancreatic necrosis Show forest plot

8

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only
Analysis 3.5
Comparison 3 Severe acute pancreatitis, Outcome 5 Infected pancreatic necrosis.

Comparison 3 Severe acute pancreatitis, Outcome 5 Infected pancreatic necrosis.

5.1 Antibiotics versus control

6

341

Odds Ratio (M‐H, Fixed, 95% CI)

0.73 [0.41, 1.33]

5.2 Probiotics versus control

2

101

Odds Ratio (M‐H, Fixed, 95% CI)

0.60 [0.22, 1.68]

6 Sepsis Show forest plot

3

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only
Analysis 3.6
Comparison 3 Severe acute pancreatitis, Outcome 6 Sepsis.

Comparison 3 Severe acute pancreatitis, Outcome 6 Sepsis.

6.1 Aprotinin versus control

2

103

Odds Ratio (M‐H, Fixed, 95% CI)

1.87 [0.50, 6.98]

6.2 Probiotics versus control

1

62

Odds Ratio (M‐H, Fixed, 95% CI)

0.36 [0.10, 1.36]

Study flow diagram.
Figuras y tablas -
Figure 1

Study flow diagram.

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Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Funnel plot of short‐term mortality indicating no evidence of reporting bias.
Figuras y tablas -
Figure 4

Funnel plot of short‐term mortality indicating no evidence of reporting bias.

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Funnel plot of infected pancreatic necrosis indicating no evidence of reporting bias.
Figuras y tablas -
Figure 5

Funnel plot of infected pancreatic necrosis indicating no evidence of reporting bias.

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Funnel plot of requirement for additional invasive intervention indicating no evidence of reporting bias.
Figuras y tablas -
Figure 6

Funnel plot of requirement for additional invasive intervention indicating no evidence of reporting bias.

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Funnel plot of serious adverse events (number) indicating that trials with lower precision favoured antibiotics without matching trials with lower precision which showed no effect or favouring control.
Figuras y tablas -
Figure 7

Funnel plot of serious adverse events (number) indicating that trials with lower precision favoured antibiotics without matching trials with lower precision which showed no effect or favouring control.

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Funnel plot of adverse events (number) indicating that trials with lower precision favoured antibiotics while trials with greater precision favoured control.
Figuras y tablas -
Figure 8

Funnel plot of adverse events (number) indicating that trials with lower precision favoured antibiotics while trials with greater precision favoured control.

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Network plot showing the treatment comparisons that included short‐term mortality. The circles represent treatments while the lines represent the comparisons between the treatments.
Figuras y tablas -
Figure 9

Network plot showing the treatment comparisons that included short‐term mortality. The circles represent treatments while the lines represent the comparisons between the treatments.

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Comparison 1 Acute pancreatitis, Outcome 1 Short‐term mortality.
Figuras y tablas -
Analysis 1.1

Comparison 1 Acute pancreatitis, Outcome 1 Short‐term mortality.

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Comparison 1 Acute pancreatitis, Outcome 2 Serious adverse events (proportion).
Figuras y tablas -
Analysis 1.2

Comparison 1 Acute pancreatitis, Outcome 2 Serious adverse events (proportion).

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Comparison 1 Acute pancreatitis, Outcome 3 Serious adverse events (number).
Figuras y tablas -
Analysis 1.3

Comparison 1 Acute pancreatitis, Outcome 3 Serious adverse events (number).

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Comparison 1 Acute pancreatitis, Outcome 4 Organ failure.
Figuras y tablas -
Analysis 1.4

Comparison 1 Acute pancreatitis, Outcome 4 Organ failure.

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Comparison 1 Acute pancreatitis, Outcome 5 Infected pancreatic necrosis.
Figuras y tablas -
Analysis 1.5

Comparison 1 Acute pancreatitis, Outcome 5 Infected pancreatic necrosis.

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Comparison 1 Acute pancreatitis, Outcome 6 Sepsis.
Figuras y tablas -
Analysis 1.6

Comparison 1 Acute pancreatitis, Outcome 6 Sepsis.

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Comparison 1 Acute pancreatitis, Outcome 7 Adverse events (proportion).
Figuras y tablas -
Analysis 1.7

Comparison 1 Acute pancreatitis, Outcome 7 Adverse events (proportion).

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Comparison 1 Acute pancreatitis, Outcome 8 Adverse events (number).
Figuras y tablas -
Analysis 1.8

Comparison 1 Acute pancreatitis, Outcome 8 Adverse events (number).

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Comparison 1 Acute pancreatitis, Outcome 9 Requirement for additional invasive intervention.
Figuras y tablas -
Analysis 1.9

Comparison 1 Acute pancreatitis, Outcome 9 Requirement for additional invasive intervention.

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Comparison 1 Acute pancreatitis, Outcome 10 Endoscopic or radiological drainage of collections.
Figuras y tablas -
Analysis 1.10

Comparison 1 Acute pancreatitis, Outcome 10 Endoscopic or radiological drainage of collections.

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Comparison 2 Acute necrotising pancreatitis, Outcome 1 Short‐term mortality.
Figuras y tablas -
Analysis 2.1

Comparison 2 Acute necrotising pancreatitis, Outcome 1 Short‐term mortality.

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Comparison 2 Acute necrotising pancreatitis, Outcome 2 Serious adverse events (proportion).
Figuras y tablas -
Analysis 2.2

Comparison 2 Acute necrotising pancreatitis, Outcome 2 Serious adverse events (proportion).

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Comparison 2 Acute necrotising pancreatitis, Outcome 3 Serious adverse events (number).
Figuras y tablas -
Analysis 2.3

Comparison 2 Acute necrotising pancreatitis, Outcome 3 Serious adverse events (number).

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Comparison 2 Acute necrotising pancreatitis, Outcome 4 Organ failure.
Figuras y tablas -
Analysis 2.4

Comparison 2 Acute necrotising pancreatitis, Outcome 4 Organ failure.

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Comparison 2 Acute necrotising pancreatitis, Outcome 5 Infected pancreatic necrosis.
Figuras y tablas -
Analysis 2.5

Comparison 2 Acute necrotising pancreatitis, Outcome 5 Infected pancreatic necrosis.

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Comparison 2 Acute necrotising pancreatitis, Outcome 6 Sepsis.
Figuras y tablas -
Analysis 2.6

Comparison 2 Acute necrotising pancreatitis, Outcome 6 Sepsis.

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Comparison 3 Severe acute pancreatitis, Outcome 1 Short‐term mortality.
Figuras y tablas -
Analysis 3.1

Comparison 3 Severe acute pancreatitis, Outcome 1 Short‐term mortality.

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Comparison 3 Severe acute pancreatitis, Outcome 2 Serious adverse events (proportion).
Figuras y tablas -
Analysis 3.2

Comparison 3 Severe acute pancreatitis, Outcome 2 Serious adverse events (proportion).

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Comparison 3 Severe acute pancreatitis, Outcome 3 Serious adverse events (number).
Figuras y tablas -
Analysis 3.3

Comparison 3 Severe acute pancreatitis, Outcome 3 Serious adverse events (number).

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Comparison 3 Severe acute pancreatitis, Outcome 4 Organ failure.
Figuras y tablas -
Analysis 3.4

Comparison 3 Severe acute pancreatitis, Outcome 4 Organ failure.

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Comparison 3 Severe acute pancreatitis, Outcome 5 Infected pancreatic necrosis.
Figuras y tablas -
Analysis 3.5

Comparison 3 Severe acute pancreatitis, Outcome 5 Infected pancreatic necrosis.

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Comparison 3 Severe acute pancreatitis, Outcome 6 Sepsis.
Figuras y tablas -
Analysis 3.6

Comparison 3 Severe acute pancreatitis, Outcome 6 Sepsis.

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Summary of findings for the main comparison. Summary of findings (mortality)

Pharmacological interventions for treatment of acute severe pancreatitis (mortality)

Patient or population: people with acute pancreatitis
Settings: secondary or tertiary setting
Intervention: various treatments
Control: inactive control

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Assumed risk

Inactive control

Corresponding risk

Various treatments

Short‐term mortality

Follow‐up: up to 3 months

Antibiotics

OR 0.81
(0.57 to 1.15)

1058
(17 studies)

⊕⊝⊝⊝
Very lowa,b,c

120 per 1000

99 per 1000
(72 to 135)

Antioxidants

OR 2.01
(0.53 to 7.56)

163
(4 studies)

⊕⊝⊝⊝
Very lowa,b,c

120 per 1000

215 per 1000
(68 to 508)

Aprotinin

OR 0.68
(0.40 to 1.14)

651
(7 studies)

⊕⊝⊝⊝
Very lowa,b,c

120 per 1000

85 per 1000
(52 to 135)

Calcitonin

OR 0.55
(0.15 to 2.00)

125
(2 studies)

⊕⊝⊝⊝
Very low1,²,3

120 per 1000

69 per 1000
(20 to 214)

Cimetidine

OR 1.00
(0.06 to 17.18)

40
(1 study)

⊕⊝⊝⊝
Very lowa,b,c

120 per 1000

120 per 1000
(8 to 701)

EDTA

OR 0.94
(0.12 to 7.08)

64
(1 study)

⊕⊝⊝⊝
Very low1,²,3

120 per 1000

113 per 1000
(17 to 491)

Gabexate

OR 0.79
(0.48 to 1.30)

576
(5 studies)

⊕⊝⊝⊝
Very lowa,b,c

120 per 1000

98 per 1000
(62 to 151)

Glucagon

OR 0.97
(0.51 to 1.87)

409
(5 studies)

⊕⊝⊝⊝
Very low1,²,3

120 per 1000

117 per 1000
(65 to 203)

Iniprol

OR 0.14
(0.01 to 1.67)

24
(1 study)

⊕⊝⊝⊝
Very lowa,b,c

120 per 1000

19 per 1000
(2 to 185)

Lexipafant

OR 0.55
(0.30 to 1.01)

423
(3 studies)

⊕⊝⊝⊝
Very low1,²,3

120 per 1000

70 per 1000
(40 to 121)

Octreotide

OR 0.76
(0.47 to 1.23)

927
(6 studies)

⊕⊝⊝⊝
Very lowa,b,c

120 per 1000

94 per 1000
(60 to 143)

Probiotics

OR 1.70
(0.87 to 3.30)

358
(2 studies)

⊕⊝⊝⊝
Very lowa,b,c,d

120 per 1000

188 per 1000
(106 to 310)

Activated protein C

OR 8.56
(0.41 to 180.52)

32
(1 study)

⊕⊝⊝⊝
Very lowa,b,c

120 per 1000

539 per 1000
(52 to 961)

Somatostatin

OR 0.57
(0.29 to 1.10)

493
(6 studies)

⊕⊝⊝⊝
Very lowa,b,c

120 per 1000

72 per 1000
(39 to 130)

Somatostatin plus omeprazole

OR 0.23
(0.05 to 1.11)

140
(1 study)

⊕⊝⊝⊝
Very lowa,b,c

120 per 1000

30 per 1000
(6 to 132)

Somatostatin plus ulinastatin

OR 0.43
(0.15 to 1.23)

122
(1 study)

⊕⊝⊝⊝
Very lowa,b,c

120 per 1000

55 per 1000
(20 to 144)

Thymosin

Not estimable

24
(1 study)

⊕⊝⊝⊝
Very lowa,b,c

120 per 1000

not estimable

Ulinastatin

OR 0.45
(0.12 to 1.72)

132
(2 studies)

⊕⊝⊝⊝
Very lowa,b,c

120 per 1000

58 per 1000
(16 to 190)

Long‐term mortality
Follow‐up: 1 year

None of the trials with inactive treatment in the control group reported long‐term mortality.

*The basis for the assumed risk is the average control group proportion across all comparisons. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: confidence intervals; OR: odds ratio; EDTA: ethylenediaminetetraacetic acid.

GRADE Working Group grades of evidence
High quality: further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: we are very uncertain about the estimate.

aRisk of bias: downgraded by one level.
bImprecision: downgraded one level for wide confidence intervals.
cImprecision: downgraded one level for small sample size.
dHeterogeneity: downgraded one level for lack of overlap of confidence intervals and high I².

Figuras y tablas -
Summary of findings for the main comparison. Summary of findings (mortality)
Ir a la tabla de la revisión
Summary of findings 2. Summary of findings (other primary outcomes)

Pharmacological interventions for treatment of acute severe pancreatitis (other outcomes)

Patient or population: people with acute pancreatitis
Settings: secondary or tertiary setting
Intervention: various treatments
Control: inactive control

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Assumed risk

Corresponding risk

Inactive control

Various treatments

Serious adverse events (proportion)

Follow‐up: up to 3 months

Antibiotics

OR 0.65
(0.37 to 1.15)

304
(5 studies)

⊕⊝⊝⊝
Very lowa,b,c

147 per 1000

101 per 1000
(60 to 166)

Antioxidants

OR 1.98
(0.48 to 8.13)

82
(2 studies)

⊕⊝⊝⊝
Very lowa,b,c

147 per 1000

255 per 1000
(77 to 584)

EDTA

OR 0.52
(0.11 to 2.39)

64
(1 study)

⊕⊝⊝⊝
Very lowa,b,c

147 per 1000

83 per 1000
(19 to 292)

Gabexate

OR 1.31
(0.31 to 5.60)

201
(2 studies)

⊕⊝⊝⊝
Very lowa,b,c

147 per 1000

185 per 1000
(51 to 492)

Glucagon

OR 0.29
(0.01 to 7.46)

127
(2 studies)

⊕⊝⊝⊝
Very lowa,b,c

147 per 1000

48 per 1000
(2 to 563)

Octreotide

OR 1.73
(0.61 to 4.93)

58
(1 study)

⊕⊝⊝⊝
Very lowa,b,c,d

147 per 1000

230 per 1000
(95 to 460)

Somatostatin

OR 1.07
(0.35 to 3.27)

111
(2 studies)

⊕⊝⊝⊝
Very lowa,b,c,d

147 per 1000

156 per 1000
(57 to 361)

Serious adverse events (number)

Follow‐up: up to 3 months

Antibiotics

Rate ratio0.86
(0.68 to 1.07)

716
(12 studies)

⊕⊝⊝⊝
Very lowa,b,c

437 per 1000

374 per 1000
(298 to 469)

Antioxidants

Rate ratio0.22
(0.02 to 2.21)

71
(2 studies)

⊕⊝⊝⊝
Very lowa,b,c

437 per 1000

94 per 1000
(9 to 967)

Aprotinin

Rate ratio0.79
(0.49 to 1.29)

264
(3 studies)

⊕⊝⊝⊝
Very lowa,b,c

437 per 1000

345 per 1000
(212 to 562)

Cimetidine

Rate ratio1.00
(0.20 to 4.95)

60
(1 study)

⊕⊝⊝⊝
Very lowa,b,c

437 per 1000

437 per 1000
(88 to 2165)

EDTA

Rate ratio0.94
(0.19 to 4.65)

64
(1 study)

⊕⊝⊝⊝
Very lowa,b,c

437 per 1000

411 per 1000
(83 to 2034)

Gabexate

Rate ratio0.86
(0.64 to 1.15)

375
(3 studies)

⊕⊝⊝⊝
Very lowa,b,c

437 per 1000

375 per 1000
(279 to 503)

Glucagon

Rate ratio1.00
(0.02 to 50.40)

68
(1 study)

⊕⊝⊝⊝
Very lowa,b,c

437 per 1000

437 per 1000
(9 to 22027)

Lexipafant

rate ratio0.67
(0.46 to 0.96)

290
(1 study)

⊕⊝⊝⊝
Very lowa,b,c

437 per 1000

292 per 1000
(203 to 420)

Octreotide

Rate ratio0.74
(0.60 to 0.89)

770
(5 studies)

⊕⊝⊝⊝
Very lowa,b,c

437 per 1000

321 per 1000
(264 to 391)

Probiotics

Rate ratio0.94
(0.65 to 1.36)

397
(3 studies)

⊕⊝⊝⊝
Very lowa,b,c,d

437 per 1000

412 per 1000
(286 to 595)

Somatostatin

Rate ratio1.03
(0.66 to 1.59)

257
(3 studies)

⊕⊝⊝⊝
Very lowa,b,c

437 per 1000

449 per 1000
(290 to 695)

Somatostatin plus omeprazole

Rate ratio0.36
(0.19 to 0.70)

140
(1 study)

⊕⊕⊝⊝
Lowa,b

437 per 1000

159 per 1000
(82 to 308)

Somatostatin plus ulinastatin

Rate ratio0.30
(0.15 to 0.60)

122
(1 study)

⊕⊕⊝⊝
Lowa,b

437 per 1000

133 per 1000
(68 to 262)

Organ failure

Follow‐up: up to 3 months

Antibiotics

OR 0.78
(0.44 to 1.38)

258
(5 studies)

⊕⊝⊝⊝
Very lowa,b,c

289 per 1000

241 per 1000
(152 to 360)

Antioxidants

OR 0.92
(0.39 to 2.12)

163
(4 studies)

⊕⊝⊝⊝
Very lowa,b,c

289 per 1000

271 per 1000
(138 to 463)

Gabexate

OR 0.32
(0.01 to 8.25)

50
(1 study)

⊕⊝⊝⊝
Very lowa,b,c

289 per 1000

115 per 1000
(5 to 770)

Lexipafant

OR 0.68
(0.36 to 1.27)

340
(2 studies)

⊕⊝⊝⊝
Very lowa,b,c

289 per 1000

216 per 1000
(128 to 341)

Octreotide

OR 0.51
(0.27 to 0.97)

430
(3 studies)

⊕⊝⊝⊝
Very lowa,b,c,d

289 per 1000

173 per 1000
(99 to 284)

Probiotics

OR 0.80
(0.26 to 2.47)

358
(2 studies)

⊕⊝⊝⊝
Very lowa,b,c,d

289 per 1000

246 per 1000
(95 to 501)

Ulinastatin

OR 0.27
(0.01 to 6.67)

129
(2 studies)

⊕⊝⊝⊝
Very lowa,b,c,d

289 per 1000

100 per 1000
(5 to 731)

Infected pancreatic necrosis

Follow‐up: up to 3 months

Antibiotics

OR 0.82
(0.53 to 1.25)

714
(11 studies)

⊕⊝⊝⊝
Very lowa,b,c

140 per 1000

118 per 1000
(80 to 169)

Octreotide

OR 0.52
(0.04 to 6.06)

58
(1 study)

⊕⊝⊝⊝
Very lowa,b,c

140 per 1000

78 per 1000
(7 to 497)

Probiotics

OR 1.10
(0.62 to 1.96)

397
(3 studies)

⊕⊝⊝⊝
Very lowa,b,c

140 per 1000

152 per 1000
(92 to 243)

Sepsis

Follow‐up: up to 3 months

Antibiotics

OR 0.42
(0.11 to 1.60)

60
(1 study)

⊕⊝⊝⊝
Very lowa,b,c

122 per 1000

56 per 1000
(15 to 182)

Aprotinin

OR 1.84
(0.49 to 6.96)

103
(2 studies)

⊕⊝⊝⊝
Very lowa,b,c

122 per 1000

204 per 1000
(63 to 492)

Gabexate

OR 1.10
(0.55 to 2.19)

373
(3 studies)

⊕⊝⊝⊝
Very lowa,b,c

122 per 1000

133 per 1000
(71 to 233)

Lexipafant

OR 0.26
(0.08 to 0.83)

290
(1 study)

⊕⊝⊝⊝
Very lowa,b,c

122 per 1000

35 per 1000
(12 to 103)

Octreotide

OR 0.40
(0.05 to 3.53)

340
(2 studies)

⊕⊝⊝⊝
Very lowa,b,c,d

122 per 1000

53 per 1000
(6 to 329)

Probiotics

OR 0.36
(0.10 to 1.36)

62
(1 study)

⊕⊝⊝⊝
Very lowa,b,c

122 per 1000

48 per 1000
(13 to 159)

Health‐related quality of life

None of the trials reported this outcome.

*The basis for the assumed risk is the average control group proportion across all comparisons. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: confidence intervals; OR = odds ratio; EDTA = ethylenediaminetetraacetic acid.

GRADE Working Group grades of evidence
High quality: further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: we are very uncertain about the estimate.

aRisk of bias: downgraded by one level.
bImprecision: downgraded one level for wide confidence intervals.
cImprecision: downgraded one level for small sample size.
dHeterogeneity: downgraded one level for lack of overlap of confidence intervals and high I².

Figuras y tablas -
Summary of findings 2. Summary of findings (other primary outcomes)
Ir a la tabla de la revisión
Table 1. Characteristics of included studies (ordered by comparisons)

Study name

No of participants randomised

Postrandomisation dropouts

No of participants for whom outcome was reported

Treatment 1

Treatment 2

Selection bias

Performance and detection bias

Attrition bias

Selective reporting bias

Other bias

Pettila 2010

32

0

32

Activated protein C

Placebo

Unclear

Low

Low

High

High

Barreda 2009

80

22

58

Antibiotics

No active intervention

Unclear

Unclear

High

Low

Unclear

Delcenserie 1996

23

0

23

Antibiotics

No active intervention

Unclear

Unclear

Low

Low

Unclear

Delcenserie 2001

81

Not stated

81

Antibiotics

No active intervention

Unclear

Unclear

Unclear

Low

Unclear

Dellinger 2007

100

0

100

Antibiotics

Placebo

Low

Low

Low

Low

High

Finch 1976

62

4

58

Antibiotics

No active intervention

Unclear

Unclear

High

Low

Unclear

Garcia‐Barrasa 2009

46

5

41

Antibiotics

Placebo

Unclear

Low

High

Low

Low

Hejtmankova 2003

41

Not stated

41

Antibiotics

No active intervention

Unclear

Unclear

Unclear

Low

Unclear

Isenmann 2004

119

5

114

Antibiotics

Placebo

Unclear

Low

High

High

High

Llukacaj 2012

80

Not stated

80

Antibiotics

Placebo

Unclear

Low

Unclear

High

Unclear

Luiten 1995

109

7

102

Antibiotics

No active intervention

Unclear

Unclear

High

Low

Unclear

Nordback 2001

90

32

58

Antibiotics

Placebo

Unclear

Unclear

High

Low

Unclear

Poropat 2015

47

0

47

Antibiotics

No active intervention

Unclear

Unclear

Low

Low

Unclear

Pederzoli 1993a

74

Not stated

74

Antibiotics

No active intervention

Unclear

Unclear

Low

Low

Unclear

Rokke 2007

73

0

73

Antibiotics

No active intervention

Unclear

High

Low

Low

High

Sainio 1995

60

0

60

Antibiotics

No active intervention

Unclear

Unclear

Low

Low

Unclear

Spicak 2002

63

Not stated

63

Antibiotics

No active intervention

Unclear

Unclear

Unclear

Low

Unclear

Spicak 2003

41

Not stated

41

Antibiotics

No active intervention

Unclear

Unclear

Unclear

Low

Unclear

Xue 2009

59

3

56

Antibiotics

No active intervention

Unclear

Unclear

High

Low

Low

Bansal 2011

44

5

39

Antioxidants

No active intervention

Unclear

High

High

Low

Low

Birk 1994

20

Not stated

20

Antioxidants

No active intervention

Unclear

Unclear

Unclear

High

Unclear

Marek 1999

73

0

73

Antioxidants

Placebo

Unclear

Unclear

Low

High

Unclear

Sateesh 2009

56

3

53

Antioxidants

No active intervention

Unclear

High

High

Low

Unclear

Siriwardena 2007

43

0

43

Antioxidants

Placebo

Low

Low

Low

Low

High

Vege 2015

28

Not stated

28

Antioxidants

Placebo

Unclear

Low

Low

Low

Unclear

Chooklin 2007

34

Not stated

34

Antioxidants plus Corticosteroids

No active intervention

Unclear

Unclear

Unclear

High

Unclear

MRC Multicentre Trial 1977

(this is a 3‐armed trial; the numbers stated included all 3 arms)

264

7

257

Aprotinin

Placebo

Unclear

Low

High

High

High

Balldin 1983

55

Not stated

55

Aprotinin

No active intervention

Unclear

Unclear

Unclear

Low

High

Berling 1994

48

Not stated

48

Aprotinin

No active intervention

Unclear

Low

Low

Low

High

Imrie 1978

161

Not stated

161

Aprotinin

Placebo

Unclear

Low

Unclear

Low

High

Imrie 1980

50

Not stated

50

Aprotinin

Placebo

Unclear

Low

Unclear

High

Unclear

Storck 1968

43

Not stated

43

Aprotinin

Placebo

Unclear

Low

Unclear

High

Unclear

Trapnell 1974

105

Not stated

105

Aprotinin

Placebo

Low

Low

Unclear

High

High

MRC Multicentre Trial 1977

(this is a 3‐armed trial; the numbers stated included all 3 arms)

264

7

257

Aprotinin

Glucagon

Unclear

Low

High

High

High

Goebell 1979

94

Not stated

94

Calcitonin

Placebo

Unclear

Low

Unclear

Low

Unclear

Martinez 1984

31

0

31

Calcitonin

Placebo

Unclear

Unclear

Low

High

Unclear

Perezdeoteyza 1980

40

Not stated

40

Cimetidine

Placebo

Unclear

Low

Unclear

High

Unclear

Sillero 1981

60

Not stated

60

Cimetidine

Placebo

Low

Unclear

Unclear

High

Unclear

Tykka 1985

64

0

64

EDTA

Placebo

Unclear

Low

Low

Low

High

Frulloni 1994

116

Not stated

116

Gabexate

Aprotinin

Unclear

Unclear

Unclear

Low

Unclear

Pederzoli 1993b

199

17

182

Gabexate

Aprotinin

Unclear

Low

High

Low

Unclear

Buchler 1993

223

Not stated

223

Gabexate

Placebo

Low

Low

Low

Low

Unclear

Chen 2000

52

Not stated

52

Gabexate

Placebo

Unclear

Unclear

Unclear

Low

Unclear

Freise 1986

50

Not stated

50

Gabexate

Placebo

Unclear

Low

Unclear

Low

Unclear

Goebell 1988

162

11

151

Gabexate

Placebo

Unclear

Low

High

Low

Unclear

Valderrama 1992

105

5

100

Gabexate

Placebo

Low

Low

High

Low

High

Kirsch 1978

150

Not stated

150

Glucagon

Atropine

Unclear

Unclear

Unclear

Low

Unclear

MRC Multicentre Trial 1977

(this is a 3‐armed trial; the numbers stated included all 3 arms)

264

7

257

Glucagon

Placebo

Unclear

Unclear

Unclear

Low

High

Debas 1980

66

Not stated

66

Glucagon

Placebo

Unclear

Low

Unclear

Low

Unclear

Dürr 1978

69

Not stated

69

Glucagon

Placebo

Unclear

Low

Unclear

High

Unclear

Kalima 1980

80

9

71

Glucagon

Placebo

Unclear

Unclear

High

Low

Unclear

Kronborg 1980

22

Not stated

22

Glucagon

Placebo

Unclear

Low

Unclear

High

Unclear

Gilsanz 1978

62

Not stated

62

Glucagon

Oxyphenonium

Unclear

Low

Unclear

Low

Unclear

Hansky 1969

24

Not stated

24

Iniprol

No active intervention

Unclear

High

Unclear

High

High

Johnson 2001

291

1

290

Lexipafant

Placebo

Unclear

Low

High

Low

High

Kingsnorth 1995

83

Not stated

83

Lexipafant

Placebo

Unclear

Low

Unclear

High

High

McKay 1997b

51

1

50

Lexipafant

Placebo

Unclear

Low

High

High

High

Bredkjaer 1988

66

9

57

NSAID

Placebo

Unclear

Unclear

Unclear

High

Unclear

Ebbehøj 1985

30

0

30

NSAID

Placebo

Unclear

Low

Low

High

High

McKay 1997a

58

0

58

Octreotide

Placebo

Low

Low

Low

Low

Unclear

Ohair 1993

180

Not stated

180

Octreotide

Placebo

Unclear

Unclear

Unclear

High

Unclear

Paran 1995

51

13

38

Octreotide

No active intervention

Unclear

High

High

Low

Unclear

Uhl 1999

302

0

302

Octreotide

Placebo

Unclear

Low

Low

Low

High

Wang 2013c

372

Not stated

372

Octreotide

No active intervention

Unclear

Unclear

High

Low

Low

Yang 2012

163

6

157

Octreotide

No active intervention

Unclear

Unclear

High

High

Low

Wang 2013b

354

Not stated

354

Octreotide plus NSAID

Octreotide

Unclear

Unclear

Unclear

High

Unclear

Guo 2015

120

Not stated

120

Octreotide plus ulinastatin

Octreotide

Unclear

Unclear

Unclear

Low

Unclear

Besselink 2008

298

2

296

Probiotics

Placebo

Low

Low

High

Low

High

Olah 2007

83

21

62

Probiotics

No active intervention

Unclear

Low

High

High

Unclear

Plaudis 2010

90

Not stated

58

Probiotics

No active intervention

Unclear

Low

Unclear

High

Unclear

Sharma 2011

50

0

50

Probiotics

Placebo

Unclear

Low

Low

High

High

Zhu 2014

39

Not stated

39

Probiotics

Placebo

Unclear

Low

Unclear

High

Unclear

Grupo Español 1996

70

9

61

Somatostatin

Placebo

Unclear

Low

High

High

Unclear

Choi 1989

71

Not stated

71

Somatostatin

No active intervention

Unclear

Unclear

Unclear

Low

Unclear

Gjørup 1992

63

Not stated

63

Somatostatin

Placebo

Unclear

Low

Unclear

Low

Unclear

Luengo 1994

100

Not stated

100

Somatostatin

No active intervention

Unclear

Low

Unclear

High

Unclear

Moreau 1986

87

3

84

Somatostatin

Placebo

Unclear

Low

Unclear

High

High

Usadel 1985

77

Not stated

77

Somatostatin

Placebo

Unclear

Low

Unclear

High

Unclear

Wang 2013a (this is a 3‐armed trial; the numbers stated included all 3 arms)

183

Not stated

183

Somatostatin

No active intervention

Unclear

Low

Unclear

Low

Low

Yang 1999

48

Not stated

48

Somatostatin

No active intervention

Unclear

Unclear

Unclear

High

Unclear

Xia 2014

140

Not stated

140

Somatostatin plus omeprazole

No active intervention

Unclear

Unclear

Unclear

Low

Unclear

Wang 2013a (this is a 3‐armed trial; the numbers stated included all 3 arms)

183

Not stated

183

Somatostatin plus ulinastatin

Placebo

Unclear

Unclear

Unclear

High

Unclear

Wang 2013a (this is a 3‐armed trial; the numbers stated included all 3 arms)

183

Not stated

183

Somatostatin plus ulinastatin

Somatostatin

Unclear

Low

Unclear

Low

Low

Wang 2016 (this is a 4‐armed trial; the numbers stated included all 4 arms)

492

0

492

Somatostatin plus ulinastatin

Somatostatin

Low

Low

Low

Low

Low

Wang 2016 (this is a 4‐armed trial; the numbers stated included all 4 arms)

492

0

492

Somatostatin plus gabexate

Somatostatin

Low

Low

Low

Low

Low

Wang 2016 (this is a 4‐armed trial; the numbers stated included all 4 arms)

492

0

492

Somatostatin plus ulinastatin plus gabexate

Somatostatin

Low

Low

Low

Low

Low

Wang 2016 (this is a 4‐armed trial; the numbers stated included all 4 arms)

492

0

492

Somatostatin plus ulinastatin

Somatostatin plus gabexate

Low

Low

Low

Low

Low

Wang 2016 (this is a 4‐armed trial; the numbers stated included all 4 arms)

492

0

492

Somatostatin plus ulinastatin plus gabexate

Somatostatin plus gabexate

Low

Low

Low

Low

Low

Wang 2016 (this is a 4‐armed trial; the numbers stated included all 4 arms)

492

0

492

Somatostatin plus ulinastatin plus gabexate

Somatostatin plus ulinastatin

Low

Low

Low

Low

Low

Wang 2011

24

Not stated

24

Thymosin

Placebo

Unclear

Low

Unclear

High

Unclear

Abraham 2013

135

6

129

Ulinastatin

Placebo

Unclear

Low

High

Low

Unclear

Chen 2002a

68

6

62

Ulinastatin

Gabexate

Unclear

Unclear

High

High

Unclear

Chen 2002b

26

1

25

Ulinastatin

Octreotide

Unclear

Unclear

High

High

Unclear
Figuras y tablas -
Table 1. Characteristics of included studies (ordered by comparisons)
Ir a la tabla de la revisión
Table 2. Potential effect modifiers (ordered by comparisons)

Study name

Treatment 1

Treatment 2

Severe pancreatitis

Necrotising pancreatitis

Organ failure

Infection

Pettila 2010

Activated protein C

Placebo

yes

not stated

not stated

not stated

Barreda 2009

Antibiotics

No active intervention

not stated

yes

not stated

not stated

Delcenserie 1996

Antibiotics

No active intervention

yes

not stated

not stated

not stated

Delcenserie 2001

Antibiotics

No active intervention

not stated

yes

not stated

not stated

Dellinger 2007

Antibiotics

Placebo

yes

yes

not stated

no

Finch 1976

Antibiotics

No active intervention

not stated

not stated

not stated

not stated

Garcia‐Barrasa 2009

Antibiotics

Placebo

yes

yes

not stated

not stated

Hejtmankova 2003

Antibiotics

No active intervention

yes

not stated

not stated

not stated

Isenmann 2004

Antibiotics

Placebo

not stated

not stated

not stated

not stated

Llukacaj 2012

Antibiotics

Placebo

not stated

yes

not stated

no

Luiten 1995

Antibiotics

No active intervention

yes

not stated

not stated

no

Nordback 2001

Antibiotics

Placebo

not stated

yes

no

not stated

Pederzoli 1993a

Antibiotics

No active intervention

not stated

yes

not stated

not stated

Rokke 2007

Antibiotics

No active intervention

yes

yes

not stated

not stated

Sainio 1995

Antibiotics

No active intervention

not stated

yes

not stated

not stated

Spicak 2002

Antibiotics

No active intervention

yes

not stated

not stated

not stated

Spicak 2003

Antibiotics

No active intervention

yes

not stated

not stated

not stated

Xue 2009

Antibiotics

No active intervention

yes

yes

not stated

no

Bansal 2011

Antioxidants

No active intervention

not stated

not stated

not stated

not stated

Birk 1994

Antioxidants

No active intervention

yes

not stated

not stated

not stated

Marek 1999

Antioxidants

Placebo

not stated

not stated

not stated

not stated

Sateesh 2009

Antioxidants

No active intervention

not stated

not stated

not stated

not stated

Siriwardena 2007

Antioxidants

Placebo

not stated

not stated

not stated

not stated

Vege 2015

Antioxidants

Placebo

not stated

not stated

not stated

not stated

Chooklin 2007

Antioxidants plus corticosteroids

No active intervention

yes

not stated

not stated

not stated

Balldin 1983

Aprotinin

No active intervention

yes

not stated

not stated

not stated

Berling 1994

Aprotinin

No active intervention

yes

not stated

not stated

not stated

Imrie 1978

Aprotinin

Placebo

not stated

not stated

not stated

not stated

Imrie 1980

Aprotinin

Placebo

not stated

not stated

not stated

not stated

MRC Multicentre Trial 1977

Aprotinin

Placebo

not stated

not stated

not stated

not stated

Storck 1968

Aprotinin

Placebo

not stated

not stated

not stated

not stated

Trapnell 1974

Aprotinin

Placebo

not stated

not stated

not stated

not stated

Goebell 1979

Calcitonin

Placebo

not stated

not stated

not stated

not stated

Martinez 1984

Calcitonin

Placebo

yes

not stated

not stated

not stated

Perezdeoteyza 1980

Cimetidine

Placebo

not stated

not stated

not stated

not stated

Sillero 1981

Cimetidine

Placebo

not stated

not stated

not stated

not stated

Tykka 1985

EDTA

Placebo

not stated

not stated

not stated

not stated

Buchler 1993

Gabexate

Placebo

not stated

not stated

not stated

not stated

Chen 2000

Gabexate

Placebo

yes

not stated

yes

not stated

Freise 1986

Gabexate

Placebo

not stated

not stated

not stated

not stated

Goebell 1988

Gabexate

Placebo

not stated

not stated

not stated

not stated

Valderrama 1992

Gabexate

Placebo

not stated

not stated

not stated

not stated

Debas 1980

Glucagon

Placebo

not stated

not stated

not stated

not stated

Dürr 1978

Glucagon

Placebo

not stated

not stated

not stated

not stated

Kalima 1980

Glucagon

Placebo

not stated

not stated

not stated

not stated

Kronborg 1980

Glucagon

Placebo

not stated

not stated

not stated

not stated

MRC Multicentre Trial 1977

Glucagon

Placebo

not stated

not stated

not stated

not stated

Hansky 1969

Iniprol

No active intervention

not stated

not stated

not stated

not stated

Johnson 2001

Lexipafant

Placebo

not stated

not stated

not stated

not stated

Kingsnorth 1995

Lexipafant

Placebo

not stated

not stated

not stated

not stated

McKay 1997b

Lexipafant

Placebo

not stated

not stated

not stated

not stated

Bredkjaer 1988

NSAID

Placebo

not stated

not stated

not stated

not stated

Ebbehøj 1985

NSAID

Placebo

not stated

not stated

not stated

not stated

McKay 1997b

Octreotide

Placebo

not stated

not stated

not stated

not stated

Ohair 1993

Octreotide

Placebo

not stated

not stated

not stated

not stated

Paran 1995

Octreotide

No active intervention

not stated

not stated

not stated

not stated

Uhl 1999

Octreotide

Placebo

not stated

not stated

not stated

not stated

Wang 2013c (mild pancreatitis)

Octreotide

No active intervention

no

not stated

not stated

not stated

Wang 2013c (severe pancreatitis)

Octreotide

No active intervention

yes

not stated

not stated

not stated

Yang 2012

Octreotide

No active intervention

no

not stated

not stated

not stated

Besselink 2008

Probiotics

Placebo

not stated

not stated

not stated

not stated

Olah 2007

Probiotics

No active intervention

yes

not stated

not stated

not stated

Plaudis 2010

Probiotics

No active intervention

yes

not stated

not stated

not stated

Sharma 2011

Probiotics

Placebo

not stated

not stated

not stated

not stated

Zhu 2014

Probiotics

Placebo

yes

not stated

not stated

not stated

Choi 1989

Somatostatin

No active intervention

not stated

not stated

not stated

not stated

Gjørup 1992

Somatostatin

Placebo

not stated

not stated

not stated

not stated

Grupo Español 1996

Somatostatin

Placebo

yes

not stated

not stated

not stated

Luengo 1994

Somatostatin

No active intervention

not stated

not stated

not stated

not stated

Moreau 1986

Somatostatin

Placebo

not stated

not stated

not stated

not stated

Usadel 1985

Somatostatin

Placebo

not stated

not stated

not stated

not stated

Wang 2013a

Somatostatin

No active intervention

yes

not stated

not stated

not stated

Yang 1999

Somatostatin

No active intervention

not stated

not stated

not stated

not stated

Xia 2014

Somatostatin plus omeprazole

No active intervention

yes

not stated

not stated

not stated

Wang 2013a

Somatostatin plus ulinastatin

No active intervention

yes

not stated

not stated

not stated

Wang 2011

Thymosin

Placebo

yes

not stated

not stated

not stated

Abraham 2013 (mild pancreatitis)

Ulinastatin

Placebo

no

not stated

not stated

no

Abraham 2013 (severe pancreatitis)

Ulinastatin

Placebo

yes

not stated

not stated

not stated

Frulloni 1994

Gabexate

Aprotinin

not stated

yes

not stated

not stated

Pederzoli 1993b

Gabexate

Aprotinin

not stated

not stated

not stated

not stated

Kirsch 1978

Glucagon

Atropine

not stated

not stated

not stated

not stated

Chen 2002a

Ulinastatin

Gabexate

no

no

no

not stated

MRC Multicentre Trial 1977

Aprotinin

Glucagon

not stated

not stated

not stated

not stated

Guo 2015

Octerotide plus ulinastatin

Octreotide

yes

not stated

not stated

not stated

Wang 2013b

Octreotide plus NSAID

Octreotide

not stated

not stated

not stated

not stated

Chen 2002b

Ulinastatin

Octreotide

yes

yes

not stated

not stated

Gilsanz 1978

Glucagon

Oxyphenonium

not stated

not stated

not stated

not stated

Poropat 2015

Antibiotics

No active intervention

not stated

not stated

not stated

no

Wang 2016

Somatostatin plus gabexate

Somatostatin

yes

not stated

not stated

not stated

Wang 2013a

Somatostatin plus ulinastatin

Somatostatin

yes

not stated

not stated

not stated

Wang 2016

Somatostatin plus ulinastatin

Somatostatin

yes

not stated

not stated

not stated

Wang 2016

Somatostatin plus ulinastatin plus gabexate

Somatostatin

yes

not stated

not stated

not stated

Wang 2016

Somatostatin plus ulinastatin

Somatostatin plus gabexate

yes

not stated

not stated

not stated

Wang 2016

Somatostatin plus ulinastatin plus gabexate

Somatostatin plus gabexate

yes

not stated

not stated

not stated

Wang 2016

Somatostatin plus ulinastatin plus gabexate

Somatostatin plus ulinastatin

yes

not stated

not stated

not stated
Figuras y tablas -
Table 2. Potential effect modifiers (ordered by comparisons)
Ir a la tabla de la revisión
Table 3. Length of hospital stay (days)

Study name

Intervention

Comparator

Number of participants in intervention

Number of participants in control

Mean or median (standard deviation or interquartile range, if reported) hospital stay in intervention group

Mean or median (standard deviation or interquartile range, if reported) hospital stay in control group

Difference

Statistical significance (P‐value if reported)

Barreda 2009

Antibiotics

No active intervention

24

34

54

45

9

Not significant

Delcenserie 1996

Antibiotics

No active intervention

11

12

27.8

22

5.8

Not significant

Finch 1976

Antibiotics

No active intervention

31

27

10.4

11.3

−0.9

Not significant

Garcia‐Barrasa 2009

Antibiotics

Placebo

22

19

21

19

2

Not significant (0.80)

Hejtmankova 2003

Antibiotics

No active intervention

20

21

18 (7.2)

25 (14.8)

−7

Not significant

Isenmann 2004

Antibiotics

Placebo

58

56

21

18

3

Not significant

Luiten 1995

Antibiotics

No active intervention

50

52

30

32

−2

Not significant

Rokke 2007

Antibiotics

No active intervention

36

37

18

22

−4

Not significant (0.32)

Sainio 1995

Antibiotics

No active intervention

30

30

33.2 (22.1)

43.8 (43.1)

−10.6

Not significant (0.24)

Spicak 2002

Antibiotics

No active intervention

33

30

18.9 (8.1)

23.8 (19.3)

−4.9

Not significant

Spicak 2003

Antibiotics

No active intervention

20

21

18 (7.2)

25 (14.8)

−7

Not significant

Xue 2009

Antibiotics

No active intervention

29

27

28.3

30.7

−2.4

Not significant

Bansal 2011

Antioxidants

No active intervention

19

20

12.8

15.1

−2.3

Not significant

Sateesh 2009

Antioxidants

No active intervention

23

30

7.2 (5)

10.3 (7)

−3.1

Not significant (0.07)

Siriwardena 2007

Antioxidants

Placebo

22

21

20.4 (24.4)

14.3 (15.7)

6.1

Not significant (0.34)

Vege 2015

Antioxidants

Placebo

14

14

3

5

−2

Not significant (0.06)

Balldin 1983

Aprotinin

No active intervention

26

29

17.3

16.5

0.8

Not significant

Berling 1994

Aprotinin

No active intervention

22

26

25 (15‐32)

33 (17‐38)

−8

Not significant (0.24)

Goebell 1979

Calcitonin

Placebo

50

44

18.3 (6.4)

20.2 (7.5)

−1.9

Not significant

Martinez 1984

Calcitonin

Placebo

14

17

24 (20.2)

30 (21.7)

−6

Not significant

Buchler 1993

Gabexate

Placebo

115

108

26 (20‐43)

23 (28‐34)

3

Not significant

Debas 1980

Glucagon

Placebo

33

33

26 (28.7)

20 (19.2)

6

Not significant

Dürr 1978

Glucagon

Placebo

33

36

32.6

26.9

5.7

Not significant

Hansky 1969

Iniprol

No active intervention

15

9

14.7 (9.3)

18.7 (10.2)

−4

Not significant

Johnson 2001

Lexipafant

Placebo

151

139

9

10

−1

Not significant

McKay 1997b

Lexipafant

Placebo

26

24

13.3

14.9

−1.6

Not significant

Bredkjaer 1988

NSAID

Placebo

27

30

9

10

−1

Not significant

Ebbehøj 1985

NSAID

Placebo

14

16

13

15

−2

Not significant

McKay 1997a

Octreotide

Placebo

28

30

10

10

0

Not significant

Ohair 1993

Octreotide

Placebo

90

90

7.3

8.2

−0.9

Not significant

Paran 1995

Octreotide

No active intervention

19

19

17.9 (13.2)

34.1 (22.7)

−16.2

Significant (0.02)

Uhl 1999

Octreotide

Placebo

199

103

21.5

21

0.5

Not significant

Wang 2013c

(mild acute pancreatitis)

Octreotide

No active intervention

157

79

14.4

15.37

−0.97

Not significant

Wang 2013c

(severe acute pancreatitis)

Octreotide

No active intervention

91

45

16

16

0

Not significant

Yang 2012

Octreotide

No active intervention

80

77

7.4 (2)

11.8 (4)

−4.4

Significant

Besselink 2008

Probiotics

Placebo

152

144

28.9 (41.5)

23.5 (25.9)

5.4

Not significant (0.98)

Olah 2007

Probiotics

No active intervention

33

29

14.9

19.7

−4.8

Not significant

Sharma 2011

Probiotics

Placebo

24

26

13.23 (18.19)

9.69 (9.69)

3.54

Not significant (0.76)

Pettila 2010

Activated protein C

Placebo

16

16

17.1

34.4

−17.3

Significant (P < 0.05)

Gjørup 1992

Somatostatin

Placebo

33

30

12

10

2

Not significant

Luengo 1994

Somatostatin

No active intervention

50

50

14.92 (11.46)

20.28 (15)

−5.36

Significant

Wang 2011

Thymosin

Placebo

12

12

37.1 (22.7)

60.6 (32.9)

−23.5

Not significant (0.06)

Abraham 2013

(mild acute pancreatitis)

Ulinastatin

Placebo

30

32

7 (5‐22)

8 (5‐15)

−1

Not significant (0.07)

Abraham 2013

(severe acute pancreatitis)

Ulinastatin

Placebo

35

32

9 (6‐22)

10 (6‐22)

−1

Not significant (0.21)

Guo 2015

Octerotide plus ulinastatin

Octreotide

60

60

11.8 (3.9)

23.7 (16.3)

−11.9

Significant

Wang 2016

Somatostatin plus ulinastatin plus gabexate

Somatostatin

116

122

17.7 (32.1)

31.3 (37.6)

‐13.6

Significant

Wang 2016

Somatostatin plus ulinastatin

Somatostatin

124

122

22.6 (34.5)

31.3 (37.6)

‐8.7

Significant

Wang 2016

Somatostatin plus gabexate

Somatostatin

130

122

23.2 (29.6)

31.3 (37.6)

‐8.1

Significant

Wang 2016

Somatostatin plus ulinastatin plus gabexate

Somatostatin plus gabexate

116

130

17.7 (32.1)

23.2 (29.6)

−5.5

Significant

Wang 2016

Somatostatin plus ulinastatin

Somatostatin plus gabexate

124

130

22.6 (34.5)

23.2 (29.6)

−0.6

Significant

Wang 2016

Somatostatin plus ulinastatin plus gabexate

Somatostatin plus ulinastatin

116

124

17.7 (32.1)

22.6 (34.5)

−4.9

Significant

NSAID: non‐steroidal anti‐inflammatory drug.

Figuras y tablas -
Table 3. Length of hospital stay (days)
Ir a la tabla de la revisión
Table 4. Length of intensive care unit (ICU) stay (days)

Study name

Intervention

Control

Number of participants in intervention

Number of participants in control

Mean or median (standard deviation or interquartile range, if reported) intensive care stay in intervention group

Mean or median (standard deviation or interquartile range, if reported) intensive care stay in control group

Difference

Statistical significance (P‐value, reported)

Garcia‐Barrasa 2009

Antibiotics

Placebo

22

19

17

18

‐1

Not significant (P‐value = 0.83)

Isenmann 2004

Antibiotics

Placebo

58

56

8

6

2

Not significant

Nordback 2001

Antibiotics

Placebo

25

33

8

8

0

Not significant

Rokke 2007

Antibiotics

No active intervention

36

37

8

7

1

Not significant (P‐value = 0.78)

Sainio 1995

Antibiotics

No active intervention

30

30

12.7 (10.7)

23.6 (28.7)

‐10.9

Not significant (P‐value = 0.06)

Spicak 2002

Antibiotics

No active intervention

33

30

11.4 (5.4)

15.9 (12)

‐4.5

Not significant

Siriwardena 2007

Antioxidants

Placebo

22

21

4 (10.3)

0 (0)

4

Not significant (P‐value = 0.08)

Vege 2015

Antioxidants

Placebo

14

14

0

0

0

Significant (P‐value = 0.03)

Berling 1994

Aprotinin

No active intervention

22

26

9.5 (4 ‐ 10)

12 (3‐20)

‐2.5

Not significant (P‐value = 0.47)

Johnson 2001

Lexipafant

Placebo

151

139

9.5

11

‐1.5

Not significant

Besselink 2008

Probiotics

Placebo

152

144

6.6 (17.1)

3 (9.3)

3.6

Not significant (P‐value = 0.08)

Sharma 2011

Probiotics

Placebo

24

26

4.94 (9.54)

4 (5.86)

0.94

Not significant (P‐value = 0.94)

Wang 2011

Thymosin

Placebo

12

12

24.6 (19.6)

50.5 (25.7)

‐25.9

Significant (P‐value = 0.01)
Figuras y tablas -
Table 4. Length of intensive care unit (ICU) stay (days)
Ir a la tabla de la revisión
Comparison 1. Acute pancreatitis

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Short‐term mortality Show forest plot

67

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 Antibiotics versus control

17

1058

Odds Ratio (M‐H, Fixed, 95% CI)

0.81 [0.57, 1.15]

1.2 Antioxidants versus control

4

163

Odds Ratio (M‐H, Fixed, 95% CI)

2.01 [0.53, 7.56]

1.3 Aprotinin versus control

7

651

Odds Ratio (M‐H, Fixed, 95% CI)

0.68 [0.40, 1.14]

1.4 Calcitonin versus control

2

125

Odds Ratio (M‐H, Fixed, 95% CI)

0.55 [0.15, 2.00]

1.5 Cimetidine versus control

1

40

Odds Ratio (M‐H, Fixed, 95% CI)

1.0 [0.06, 17.18]

1.6 EDTA versus control

1

64

Odds Ratio (M‐H, Fixed, 95% CI)

0.94 [0.12, 7.08]

1.7 Gabexate versus control

5

576

Odds Ratio (M‐H, Fixed, 95% CI)

0.79 [0.48, 1.30]

1.8 Glucagon versus control

5

409

Odds Ratio (M‐H, Fixed, 95% CI)

0.97 [0.51, 1.87]

1.9 Iniprol versus control

1

24

Odds Ratio (M‐H, Fixed, 95% CI)

0.14 [0.01, 1.67]

1.10 Lexipafant versus control

3

423

Odds Ratio (M‐H, Fixed, 95% CI)

0.55 [0.30, 1.01]

1.11 Octreotide versus control

5

927

Odds Ratio (M‐H, Fixed, 95% CI)

0.76 [0.47, 1.23]

1.12 Probiotics versus control

2

358

Odds Ratio (M‐H, Fixed, 95% CI)

1.70 [0.87, 3.30]

1.13 Activated protein C versus control

1

32

Odds Ratio (M‐H, Fixed, 95% CI)

8.56 [0.41, 180.52]

1.14 Somatostatin versus control

6

493

Odds Ratio (M‐H, Fixed, 95% CI)

0.57 [0.29, 1.10]

1.15 Somatostatin plus omeprazole versus control

1

140

Odds Ratio (M‐H, Fixed, 95% CI)

0.23 [0.05, 1.11]

1.16 Somatostatin plus ulinastatin versus control

1

122

Odds Ratio (M‐H, Fixed, 95% CI)

0.43 [0.15, 1.23]

1.17 Thymosin versus control

1

24

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.18 Ulinastatin versus control

1

132

Odds Ratio (M‐H, Fixed, 95% CI)

0.45 [0.12, 1.72]

1.19 Gabexate versus aprotinin

2

298

Odds Ratio (M‐H, Fixed, 95% CI)

0.62 [0.32, 1.20]

1.20 Glucagon versus aprotinin

1

134

Odds Ratio (M‐H, Fixed, 95% CI)

1.33 [0.44, 4.08]

1.21 Glucagon versus atropine

1

150

Odds Ratio (M‐H, Fixed, 95% CI)

4.17 [0.45, 38.21]

1.22 Octreotide plus ulinastatin versus octreotide

1

120

Odds Ratio (M‐H, Fixed, 95% CI)

0.31 [0.06, 1.60]

1.23 Somatostatin plus gabexate versus somatostatin

1

252

Odds Ratio (M‐H, Fixed, 95% CI)

0.93 [0.37, 2.33]

1.24 Somatostatin plus ulinastatin versus somatostatin

2

369

Odds Ratio (M‐H, Fixed, 95% CI)

0.73 [0.34, 1.56]

1.25 Somatostatin plus ulinastatin plus gabexate versus somatostatin

1

238

Odds Ratio (M‐H, Fixed, 95% CI)

0.61 [0.21, 1.74]

1.26 Somatostatin plus ulinastatin versus somatostatin plus gabexate

1

254

Odds Ratio (M‐H, Fixed, 95% CI)

0.72 [0.26, 1.95]

1.27 Somatostatin plus ulinastatin plus gabexate versus somatostatin plus gabexate

1

246

Odds Ratio (M‐H, Fixed, 95% CI)

0.65 [0.23, 1.86]

1.28 Somatostatin plus ulinastatin plus gabexate versus somatostatin plus ulinastatin

1

240

Odds Ratio (M‐H, Fixed, 95% CI)

0.91 [0.30, 2.80]

2 Serious adverse events (proportion) Show forest plot

17

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 Antibiotics versus control

5

304

Odds Ratio (M‐H, Fixed, 95% CI)

0.65 [0.37, 1.15]

2.2 Antioxidants versus control

2

82

Odds Ratio (M‐H, Fixed, 95% CI)

1.98 [0.48, 8.13]

2.3 EDTA versus control

1

64

Odds Ratio (M‐H, Fixed, 95% CI)

0.52 [0.11, 2.39]

2.4 Gabexate versus control

2

201

Odds Ratio (M‐H, Fixed, 95% CI)

1.31 [0.31, 5.60]

2.5 Glucagon versus control

2

127

Odds Ratio (M‐H, Fixed, 95% CI)

0.29 [0.01, 7.46]

2.6 Octreotide versus control

1

58

Odds Ratio (M‐H, Fixed, 95% CI)

1.73 [0.61, 4.93]

2.7 Somatostatin versus control

2

111

Odds Ratio (M‐H, Fixed, 95% CI)

1.07 [0.35, 3.27]

2.8 Gabexate versus aprotinin

1

116

Odds Ratio (M‐H, Fixed, 95% CI)

1.05 [0.22, 4.91]

2.9 Ulinastatin versus gabexate

1

62

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Serious adverse events (number) Show forest plot

37

Rate Ratio (Fixed, 95% CI)

Subtotals only

3.1 Antibiotics versus control

12

716

Rate Ratio (Fixed, 95% CI)

0.86 [0.68, 1.07]

3.2 Antioxidants versus control

2

71

Rate Ratio (Fixed, 95% CI)

0.22 [0.02, 2.21]

3.3 Aprotinin versus control

3

264

Rate Ratio (Fixed, 95% CI)

0.79 [0.49, 1.29]

3.4 Cimetidine versus control

1

60

Rate Ratio (Fixed, 95% CI)

1.0 [0.20, 4.95]

3.5 EDTA versus control

1

64

Rate Ratio (Fixed, 95% CI)

0.94 [0.19, 4.65]

3.6 Gabexate versus control

3

375

Rate Ratio (Fixed, 95% CI)

0.86 [0.64, 1.15]

3.7 Glucagon versus control

1

68

Rate Ratio (Fixed, 95% CI)

1.0 [0.02, 50.40]

3.8 Lexipafant versus control

1

290

Rate Ratio (Fixed, 95% CI)

0.67 [0.46, 0.96]

3.9 Octreotide versus control

4

770

Rate Ratio (Fixed, 95% CI)

0.74 [0.60, 0.89]

3.10 Probiotics versus control

3

397

Rate Ratio (Fixed, 95% CI)

0.94 [0.65, 1.36]

3.11 Somatostatin versus control

3

257

Rate Ratio (Fixed, 95% CI)

1.03 [0.66, 1.59]

3.12 Somatostatin plus omeprazole versus control

1

140

Rate Ratio (Fixed, 95% CI)

0.36 [0.19, 0.70]

3.13 Somatostatin plus ulinastatin versus control

1

122

Rate Ratio (Fixed, 95% CI)

0.30 [0.15, 0.60]

3.14 Glucagon versus atropine

1

150

Rate Ratio (Fixed, 95% CI)

0.33 [0.03, 3.20]

3.15 Octreotide plus ulinastatin versus octreotide

1

120

Rate Ratio (Fixed, 95% CI)

0.30 [0.17, 0.51]

3.16 Somatostatin plus ulinastatin versus somatostatin

1

123

Rate Ratio (Fixed, 95% CI)

0.28 [0.15, 0.56]

4 Organ failure Show forest plot

18

Odds Ratio (M‐H, Random, 95% CI)

Subtotals only

4.1 Antibiotics versus control

5

258

Odds Ratio (M‐H, Random, 95% CI)

0.78 [0.44, 1.38]

4.2 Antioxidants versus control

4

163

Odds Ratio (M‐H, Random, 95% CI)

0.92 [0.39, 2.12]

4.3 Gabexate versus control

1

50

Odds Ratio (M‐H, Random, 95% CI)

0.32 [0.01, 8.25]

4.4 Lexipafant versus control

2

340

Odds Ratio (M‐H, Random, 95% CI)

0.68 [0.36, 1.27]

4.5 Octreotide versus control

2

430

Odds Ratio (M‐H, Random, 95% CI)

0.51 [0.27, 0.97]

4.6 Probiotics versus control

2

358

Odds Ratio (M‐H, Random, 95% CI)

0.80 [0.26, 2.47]

4.7 Ulinastatin versus control

1

129

Odds Ratio (M‐H, Random, 95% CI)

0.27 [0.01, 6.67]

4.8 Somatostatin plus gabexate versus somatostatin

1

252

Odds Ratio (M‐H, Random, 95% CI)

0.78 [0.33, 1.80]

4.9 Somatostatin plus ulinastatin versus somatostatin

1

246

Odds Ratio (M‐H, Random, 95% CI)

0.58 [0.23, 1.45]

4.10 Somatostatin plus ulinastatin plus gabexate versus somatostatin

1

238

Odds Ratio (M‐H, Random, 95% CI)

0.46 [0.17, 1.25]

4.11 Somatostatin plus ulinastatin versus somatostatin plus gabexate

1

254

Odds Ratio (M‐H, Random, 95% CI)

0.75 [0.29, 1.92]

4.12 Somatostatin plus ulinastatin plus gabexate versus somatostatin plus gabexate

1

246

Odds Ratio (M‐H, Random, 95% CI)

0.59 [0.21, 1.65]

4.13 Somatostatin plus ulinastatin plus gabexate versus somatostatin plus ulinastatin

1

240

Odds Ratio (M‐H, Random, 95% CI)

0.79 [0.27, 2.35]

5 Infected pancreatic necrosis Show forest plot

15

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 Antibiotics versus control

11

714

Odds Ratio (M‐H, Fixed, 95% CI)

0.82 [0.53, 1.25]

5.2 Octreotide versus control

1

58

Odds Ratio (M‐H, Fixed, 95% CI)

0.52 [0.04, 6.06]

5.3 Probiotics versus control

3

397

Odds Ratio (M‐H, Fixed, 95% CI)

1.10 [0.62, 1.96]

6 Sepsis Show forest plot

11

Odds Ratio (M‐H, Random, 95% CI)

Subtotals only

6.1 Antibiotics versus control

1

60

Odds Ratio (M‐H, Random, 95% CI)

0.42 [0.11, 1.60]

6.2 Aprotinin versus control

2

103

Odds Ratio (M‐H, Random, 95% CI)

1.84 [0.49, 6.96]

6.3 Gabexate versus control

3

373

Odds Ratio (M‐H, Random, 95% CI)

1.10 [0.55, 2.19]

6.4 Lexipafant versus control

1

290

Odds Ratio (M‐H, Random, 95% CI)

0.26 [0.08, 0.83]

6.5 Octreotide versus control

2

340

Odds Ratio (M‐H, Random, 95% CI)

0.40 [0.05, 3.53]

6.6 Probiotics versus control

1

62

Odds Ratio (M‐H, Random, 95% CI)

0.36 [0.10, 1.36]

6.7 Gabexate versus aprotinin

1

116

Odds Ratio (M‐H, Random, 95% CI)

1.05 [0.22, 4.91]

7 Adverse events (proportion) Show forest plot

27

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

7.1 Antibiotics versus control

6

429

Odds Ratio (M‐H, Fixed, 95% CI)

0.51 [0.32, 0.80]

7.2 Antioxidants versus control

1

39

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

7.3 Calcitonin versus control

1

94

Odds Ratio (M‐H, Fixed, 95% CI)

0.88 [0.12, 6.49]

7.4 EDTA versus control

1

64

Odds Ratio (M‐H, Fixed, 95% CI)

0.79 [0.27, 2.31]

7.5 Gabexate versus control

3

373

Odds Ratio (M‐H, Fixed, 95% CI)

0.83 [0.54, 1.27]

7.6 Glucagon versus control

2

127

Odds Ratio (M‐H, Fixed, 95% CI)

0.09 [0.00, 1.69]

7.7 Lexipafant versus control

1

83

Odds Ratio (M‐H, Fixed, 95% CI)

0.43 [0.16, 1.12]

7.8 Octreotide versus control

3

398

Odds Ratio (M‐H, Fixed, 95% CI)

1.00 [0.65, 1.55]

7.9 Probiotics versus control

1

62

Odds Ratio (M‐H, Fixed, 95% CI)

0.35 [0.12, 1.01]

7.10 Somatostatin versus control

2

111

Odds Ratio (M‐H, Fixed, 95% CI)

0.44 [0.19, 1.02]

7.11 Somatostatin plus omeprazole versus control

1

140

Odds Ratio (M‐H, Fixed, 95% CI)

0.00 [0.00, 0.04]

7.12 Gabexate versus aprotinin

2

298

Odds Ratio (M‐H, Fixed, 95% CI)

0.41 [0.23, 0.70]

7.13 Ulinastatin versus gabexate

1

62

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

7.14 Ulinastatin versus octreotide

1

25

Odds Ratio (M‐H, Fixed, 95% CI)

2.33 [0.46, 11.81]

7.15 Somatostatin plus gabexate versus somatostatin

1

252

Odds Ratio (M‐H, Fixed, 95% CI)

0.93 [0.44, 1.95]

7.16 Somatostatin plus ulinastatin versus somatostatin

1

246

Odds Ratio (M‐H, Fixed, 95% CI)

0.58 [0.25, 1.34]

7.17 Somatostatin plus ulinastatin plus gabexate versus somatostatin

1

238

Odds Ratio (M‐H, Fixed, 95% CI)

0.49 [0.20, 1.20]

7.18 Somatostatin plus ulinastatin versus somatostatin plus gabexate

1

254

Odds Ratio (M‐H, Fixed, 95% CI)

0.63 [0.27, 1.44]

7.19 Somatostatin plus ulinastatin plus gabexate versus somatostatin plus gabexate

1

246

Odds Ratio (M‐H, Fixed, 95% CI)

0.53 [0.22, 1.28]

7.20 Somatostatin plus ulinastatin plus gabexate versus somatostatin plus ulinastatin

1

240

Odds Ratio (M‐H, Fixed, 95% CI)

0.84 [0.32, 2.22]

8 Adverse events (number) Show forest plot

40

Rate Ratio (Random, 95% CI)

Subtotals only

8.1 Antibiotics versus control

12

755

Rate Ratio (Random, 95% CI)

0.75 [0.58, 0.95]

8.2 Antioxidants versus control

2

94

Rate Ratio (Random, 95% CI)

0.82 [0.38, 1.79]

8.3 Aprotinin versus control

3

264

Rate Ratio (Random, 95% CI)

0.98 [0.69, 1.39]

8.4 Calcitonin versus control

1

94

Rate Ratio (Random, 95% CI)

0.88 [0.12, 6.25]

8.5 Cimetidine versus control

1

60

Rate Ratio (Random, 95% CI)

1.14 [0.64, 2.02]

8.6 EDTA versus control

1

64

Rate Ratio (Random, 95% CI)

0.63 [0.28, 1.39]

8.7 Gabexate versus control

3

375

Rate Ratio (Random, 95% CI)

0.76 [0.61, 0.95]

8.8 Glucagon versus control

2

90

Rate Ratio (Random, 95% CI)

1.19 [0.51, 2.80]

8.9 Lexipafant versus control

1

290

Rate Ratio (Random, 95% CI)

0.61 [0.44, 0.85]

8.10 Octreotide versus control

4

634

Rate Ratio (Random, 95% CI)

0.78 [0.58, 1.05]

8.11 Probiotics versus control

3

397

Rate Ratio (Random, 95% CI)

0.84 [0.52, 1.36]

8.12 Somatostatin versus control

2

134

Rate Ratio (Random, 95% CI)

0.75 [0.26, 2.18]

8.13 Ulinastatin versus control

1

129

Rate Ratio (Random, 95% CI)

0.69 [0.32, 1.46]

8.14 Gabexate versus aprotinin

1

182

Rate Ratio (Random, 95% CI)

0.66 [0.38, 1.14]

8.15 Glucagon versus atropine

1

150

Rate Ratio (Random, 95% CI)

0.79 [0.36, 1.73]

8.16 Oxyphenonium versus glucagon

1

62

Rate Ratio (Random, 95% CI)

0.93 [0.65, 1.34]

8.17 Octreotide plus ulinastatin versus octreotide

1

120

Rate Ratio (Random, 95% CI)

0.29 [0.17, 0.48]

9 Requirement for additional invasive intervention Show forest plot

32

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

9.1 Antibiotics versus control

14

884

Odds Ratio (M‐H, Fixed, 95% CI)

0.82 [0.59, 1.13]

9.2 Aprotinin versus control

2

237

Odds Ratio (M‐H, Fixed, 95% CI)

0.59 [0.23, 1.47]

9.3 Calcitonin versus control

2

125

Odds Ratio (M‐H, Fixed, 95% CI)

0.30 [0.08, 1.16]

9.4 Cimetidine versus control

1

60

Odds Ratio (M‐H, Fixed, 95% CI)

0.13 [0.01, 2.61]

9.5 EDTA versus control

1

64

Odds Ratio (M‐H, Fixed, 95% CI)

0.68 [0.14, 3.29]

9.6 Gabexate versus control

3

426

Odds Ratio (M‐H, Fixed, 95% CI)

0.58 [0.37, 0.90]

9.7 Glucagon versus control

2

260

Odds Ratio (M‐H, Fixed, 95% CI)

1.26 [0.58, 2.77]

9.8 Octreotide versus control

3

854

Odds Ratio (M‐H, Fixed, 95% CI)

0.76 [0.48, 1.21]

9.9 Probiotics versus control

2

358

Odds Ratio (M‐H, Fixed, 95% CI)

1.50 [0.83, 2.71]

9.10 Somatostatin versus control

1

100

Odds Ratio (M‐H, Fixed, 95% CI)

0.40 [0.11, 1.38]

9.11 Gabexate versus aprotinin

1

182

Odds Ratio (M‐H, Fixed, 95% CI)

0.5 [0.19, 1.32]

9.12 Glucagon versus aprotinin

1

134

Odds Ratio (M‐H, Fixed, 95% CI)

1.33 [0.44, 4.08]

9.13 Oxyphenonium versus glucagon

1

62

Odds Ratio (M‐H, Fixed, 95% CI)

1.0 [0.13, 7.59]

10 Endoscopic or radiological drainage of collections Show forest plot

3

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

10.1 Antibiotics versus control

1

23

Odds Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 9.07]

10.2 Octreotide versus control

1

372

Odds Ratio (M‐H, Fixed, 95% CI)

0.89 [0.40, 1.96]

10.3 Probiotics versus control

1

39

Odds Ratio (M‐H, Fixed, 95% CI)

0.94 [0.20, 4.44]
Figuras y tablas -
Comparison 1. Acute pancreatitis
Ir a la tabla de la revisión
Comparison 2. Acute necrotising pancreatitis

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Short‐term mortality Show forest plot

11

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 Antibiotics versus control

10

683

Odds Ratio (M‐H, Fixed, 95% CI)

0.82 [0.52, 1.30]

1.2 Gabexate versus aprotinin

1

116

Odds Ratio (M‐H, Fixed, 95% CI)

0.52 [0.20, 1.36]

2 Serious adverse events (proportion) Show forest plot

5

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 Antibiotics versus control

4

281

Odds Ratio (M‐H, Fixed, 95% CI)

0.84 [0.46, 1.54]

2.2 Gabexate versus aprotinin

1

116

Odds Ratio (M‐H, Fixed, 95% CI)

1.05 [0.22, 4.91]

3 Serious adverse events (number) Show forest plot

7

Rate Ratio (Fixed, 95% CI)

Subtotals only

3.1 Antibiotics versus control

7

Rate Ratio (Fixed, 95% CI)

0.79 [0.59, 1.06]

4 Organ failure Show forest plot

4

Odds Ratio (M‐H, Random, 95% CI)

Subtotals only

4.1 Antibiotics versus control

4

211

Odds Ratio (M‐H, Random, 95% CI)

0.78 [0.42, 1.45]

5 Infected pancreatic necrosis Show forest plot

6

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 Antibiotics versus control

6

426

Odds Ratio (M‐H, Fixed, 95% CI)

0.85 [0.51, 1.42]

6 Sepsis Show forest plot

2

Odds Ratio (M‐H, Random, 95% CI)

Subtotals only

6.1 Antibiotics versus control

1

60

Odds Ratio (M‐H, Random, 95% CI)

0.42 [0.11, 1.60]

6.2 Gabexate versus aprotinin

1

116

Odds Ratio (M‐H, Random, 95% CI)

1.05 [0.22, 4.91]
Figuras y tablas -
Comparison 2. Acute necrotising pancreatitis
Ir a la tabla de la revisión
Comparison 3. Severe acute pancreatitis

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Short‐term mortality Show forest plot

22

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 Antibiotics versus control

9

542

Odds Ratio (M‐H, Fixed, 95% CI)

0.82 [0.53, 1.27]

1.2 Aprotinin versus control

2

103

Odds Ratio (M‐H, Fixed, 95% CI)

0.66 [0.19, 2.30]

1.3 Calcitonin versus control

1

31

Odds Ratio (M‐H, Fixed, 95% CI)

0.78 [0.11, 5.46]

1.4 Gabexate versus control

1

52

Odds Ratio (M‐H, Fixed, 95% CI)

0.19 [0.04, 0.99]

1.5 Probiotics versus control

1

62

Odds Ratio (M‐H, Fixed, 95% CI)

0.25 [0.05, 1.34]

1.6 Activated protein C versus control

1

32

Odds Ratio (M‐H, Fixed, 95% CI)

8.56 [0.41, 180.52]

1.7 Somatostatin versus control

2

182

Odds Ratio (M‐H, Fixed, 95% CI)

0.51 [0.21, 1.23]

1.8 Somatostatin plus omeprazole versus control

1

140

Odds Ratio (M‐H, Fixed, 95% CI)

0.23 [0.05, 1.11]

1.9 Somatostatin plus ulinastatin versus control

1

122

Odds Ratio (M‐H, Fixed, 95% CI)

0.43 [0.15, 1.23]

1.10 Thymosin versus control

1

24

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.11 Ulinastatin versus control

1

70

Odds Ratio (M‐H, Fixed, 95% CI)

0.24 [0.04, 1.29]

1.12 Octreotide plus ulinastatin versus octreotide

1

120

Odds Ratio (M‐H, Fixed, 95% CI)

0.31 [0.06, 1.60]

1.13 Somatostatin plus gabexate versus somatostatin

1

252

Odds Ratio (M‐H, Fixed, 95% CI)

0.93 [0.37, 2.33]

1.14 Somatostatin plus ulinastatin versus somatostatin

2

369

Odds Ratio (M‐H, Fixed, 95% CI)

0.73 [0.34, 1.56]

1.15 Somatostatin plus ulinastatin plus gabexate versus somatostatin

1

238

Odds Ratio (M‐H, Fixed, 95% CI)

0.61 [0.21, 1.74]

1.16 Somatostatin plus ulinastatin versus somatostatin plus gabexate

1

254

Odds Ratio (M‐H, Fixed, 95% CI)

0.72 [0.26, 1.95]

1.17 Somatostatin plus ulinastatin plus gabexate versus somatostatin plus gabexate

1

246

Odds Ratio (M‐H, Fixed, 95% CI)

0.65 [0.23, 1.86]

1.18 Somatostatin plus ulinastatin plus gabexate versus somatostatin plus ulinastatin

1

240

Odds Ratio (M‐H, Fixed, 95% CI)

0.91 [0.30, 2.80]

2 Serious adverse events (proportion) Show forest plot

3

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 Antibiotics versus control

3

164

Odds Ratio (M‐H, Fixed, 95% CI)

0.56 [0.27, 1.18]

3 Serious adverse events (number) Show forest plot

13

Rate Ratio (Random, 95% CI)

Subtotals only

3.1 Antibiotics versus control

5

Rate Ratio (Random, 95% CI)

0.81 [0.52, 1.25]

3.2 Aprotinin versus control

2

Rate Ratio (Random, 95% CI)

0.65 [0.25, 1.71]

3.3 Gabexate versus control

1

Rate Ratio (Random, 95% CI)

0.64 [0.37, 1.10]

3.4 Probiotics versus control

2

Rate Ratio (Random, 95% CI)

0.62 [0.24, 1.59]

3.5 Somatostatin versus control

1

Rate Ratio (Random, 95% CI)

1.07 [0.67, 1.69]

3.6 Somatostatin plus omeprazole versus control

1

Rate Ratio (Random, 95% CI)

0.36 [0.19, 0.70]

3.7 Somatostatin plus ulinastatin versus control

1

Rate Ratio (Random, 95% CI)

0.30 [0.15, 0.60]

3.8 Octreotide plus ulinastatin versus octreotide

1

Rate Ratio (Random, 95% CI)

0.30 [0.17, 0.51]

3.9 Somatostatin plus ulinastatin versus somatostatin

1

Rate Ratio (Random, 95% CI)

0.28 [0.15, 0.56]

4 Organ failure Show forest plot

6

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 Antibiotics versus control

3

137

Odds Ratio (M‐H, Fixed, 95% CI)

0.89 [0.40, 1.99]

4.2 Lexipafant versus control

0

0

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.3 Probiotics versus control

1

62

Odds Ratio (M‐H, Fixed, 95% CI)

0.40 [0.12, 1.36]

4.4 Ulinastatin versus control

1

67

Odds Ratio (M‐H, Fixed, 95% CI)

0.05 [0.01, 0.21]

4.5 Somatostatin plus gabexate versus somatostatin

1

252

Odds Ratio (M‐H, Fixed, 95% CI)

0.78 [0.33, 1.80]

4.6 Somatostatin plus ulinastatin versus somatostatin

1

246

Odds Ratio (M‐H, Fixed, 95% CI)

0.58 [0.23, 1.45]

4.7 Somatostatin plus ulinastatin plus gabexate versus somatostatin

1

238

Odds Ratio (M‐H, Fixed, 95% CI)

0.46 [0.17, 1.25]

4.8 Somatostatin plus ulinastatin versus somatostatin plus gabexate

1

254

Odds Ratio (M‐H, Fixed, 95% CI)

0.75 [0.29, 1.92]

4.9 Somatostatin plus ulinastatin plus gabexate versus somatostatin plus gabexate

1

246

Odds Ratio (M‐H, Fixed, 95% CI)

0.59 [0.21, 1.65]

4.10 Somatostatin plus ulinastatin plus gabexate versus somatostatin plus ulinastatin

1

240

Odds Ratio (M‐H, Fixed, 95% CI)

0.79 [0.27, 2.35]

5 Infected pancreatic necrosis Show forest plot

8

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 Antibiotics versus control

6

341

Odds Ratio (M‐H, Fixed, 95% CI)

0.73 [0.41, 1.33]

5.2 Probiotics versus control

2

101

Odds Ratio (M‐H, Fixed, 95% CI)

0.60 [0.22, 1.68]

6 Sepsis Show forest plot

3

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

6.1 Aprotinin versus control

2

103

Odds Ratio (M‐H, Fixed, 95% CI)

1.87 [0.50, 6.98]

6.2 Probiotics versus control

1

62

Odds Ratio (M‐H, Fixed, 95% CI)

0.36 [0.10, 1.36]
Figuras y tablas -
Comparison 3. Severe acute pancreatitis
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