The fourth study, recently completed in Poland, has been published in abstract form only. A total of 280 patients with suspected ABP underwent duodenoscopy within 24 h of admission. The 75 patients who were found to have stones impacted at the papilla underwent immediate ES. The remaining patients were randomly assigned to either immediate ERCP or conventional therapy. ERCP and ES were associated with a significant decrease in complications (17% versus 36%) and mortality (2% versus 13%). Moreover, earlier timing of ERCP correlated with decreased morbidity and mortality, and the benefits of early endoscopic therapy applied also to patients with mild pancreatitis. A detailed analysis of this study, however, will require publication as a full-length article.
The designs of these four RCTs differ from each other. Differences in the ethnic characteristics of the patients, the environment and even technical expertise might also have been important. Therefore, it is difficult to come to a single set of recommendations based on these data. The studies from the United Kingdom and Hong Kong support the use of early endoscopic intervention in patients with severe disease, while the Polish study suggests that patients with milder disease mayalso benefit. The German study appears to provide contradictory results, but it might actually have been complementary because it included patients who probably would not have been enrolled in the studies from the United Kingdom and Hong Kong. The results of a recent meta-analysis also support the use of early intervention. There is no more need to hesitate and you can start your treatment very soon, having spent several times less money. All you need at this point is to purchase cialis online pharmacy buy here and be sure you will be given all the best quality stuff at the reliable pharmacy of your choice.