Early Abdominal Paracentesis for Ascites in Acute Pancreatitis: A Systematic Review and Meta-Analysis

Ascites in acute pancreatitis (AP) is a poor prognostic marker and contributes to systemic inflammation, rise in intraabdominal pressure, and poor outcomes. It is not known whether early paracentesis is of any benefit hence we decided to undertake a meta-analysis.

Comprehensive review of three major databases (MEDLINE, EMBASE and Scopus) was done using a prespecified search strategy. References were sorted in Rayyan. Data on primary outcome of mortality were extracted from studies comparing early paracentesis to no intervention. Pooled relative risk (RR) was calculated using random-effects meta-analysis with inverse variance weightage. Risk of bias was assessed using Newcastle-Ottawa scale for non-randomized studies and Rob2 for randomized controlled trials (RCTs). Publication bias was assessed using funnel plot. (PROSPERO CRD420251034110).

Of the 227 citations obtained from the three databases, 11 studies with 1535 participants were shortlisted based on prespecified inclusion criteria. Only 3 of the included observational studies had Newcastle-Ottawa score of < 7, while the two RCTs had some concerns of bias. The RR of mortality was 0.56, 95% confidence interval (CI) 0.38 to 0.84. Post hoc sensitivity analysis after excluding results of 5 studies from same center yielded RR 0.63 (95% CI 0.32 to 1.22). Further sensitivity analysis of only RCTs yielded pooled RR to be 0.69 (95% CI 0.33 to 1.45).

Early paracentesis decreases risk of mortality in AP. However, the data are not robust since sensitivity analysis did not reveal significant point estimates. Adequately powered further studies are warranted to explore utility of paracentesis in AP.