Therapeutic Outcomes and Risks of Plasmapheresis in Hypertriglyceridemia Acute Pancreatitis: A Systematic Review and Meta-analysis
In brief
Plasmapheresis sharply lowers triglycerides but does not improve mortality in hypertriglyceridemic pancreatitis
In a meta-analysis of 20 studies (1,576 patients), plasma exchange cut serum triglycerides by about ten standard-deviation units within 24-48 hours, yet in-hospital death, complications and need for invasive procedures were unchanged compared with standard care. The procedure also lengthened stay and raised costs, so routine use cannot be recommended pending larger trials.
- Journal
- Digestion (Q1)
- Published
- 26 August 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Ningning Cui, Wen Wang, Wei Xu
- PMID
- 42647439
- DOI
- 10.1159/dig/acmag004
Why clinicians should know about it
- Picked for Gastroenterology (top studies of the week, 30 August 2026): Plasmapheresis in hypertriglyceridemia acute pancreatitis
Abstract
BACKGROUND: Hypertriglyceridemia acute pancreatitis (HTG-AP) is constantly increasing and has a higher proportion of severe cases. The benefit of plasmapheresis as a therapeutic intervention for HTG-AP remains controversial. Thus we conducted a meta-analysis to search existing evidence to evaluate its efficacy and safety. METHODS: A comprehensive literature search was performed in key electronic databases to search eligible studies based on predetermined criteria. Included studies compared plasmapheresis combined with standard medical therapy (Plasmapheresis group, PE group) versus standard medical therapy alone (Control group) in HTG-AP patients. Study outcomes were the 24-hour serum triglyceride (TG) reduction rate, in-hospital mortality, incidence of local/systemic complications, hospital length of stay (LOS), hospitalization costs, and recurrence rate. RESULTS: A total of 986 articles were retrieved and 20 studies involving 1,576 patients (PE group: n=636; Control group: n=940) were included. Analysis revealed that no statistically significant difference was found in mortality (RR 1.43, 95%CI 0.91-2.26, P=0.12), incidence of systemic complications (RR: 0.96; 95%CI: 0.61-1.50; P = 0.86), incidence of local complications (RR 1.01, 95% CI 0.84-1.21; P=0.91) , requirement for invasive procedures (RR 0.86, 95% CI 0.48-1.54, P=0.62) between PE group and Control group. PE group has higher TG reduction at both 24h (SMD 10.13, 95% CI 3.39-16.87, P<0.01) and 48h (SMD 8.14, 95%CI 4.30-11.98, P<0.0001) compared with control group. PE group exhibited a prolonged LOS (WMD 2.40, 95%CI 0.14-4.66, P=0.04) alongside substantially increased costs (WMD 27.56, 95%CI 16.61-38.51, P<0.00001). Subgroup analysis indicated plasmapheresis increased mortality in non-severe cases. CONCLUSION: While plasmapheresis significantly reduces serum TG levels, it confers no significant benefit on critical clinical outcomes in HTG-AP. Thus existing clinical evidence does not support its use as a routine treatment for HTG-AP. Large-scale RCTs should be carried out to further evaluate its efficacy, optimal indications, and timing. KEY WORDS: plasmapheresis; plasma exchange; double filtration plasmapheresis; hypertriglyceridemic acute pancreatitis; meta-analysis.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.