Updated meta-analysis of pancreatic stent placement in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis

Abstract

Aim: To investigate the efficacy and safety profile of pancreatic duct (PD) stent placement for prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP).

Methods: We performed a search of MEDLINE, EMBASE, and Cochrane Library to identify randomized controlled clinical trials of prophylactic PD stent placement after ERCP. RevMan 5 software provided by Cochrane was used for the heterogeneity and efficacy analyses, and a meta-analysis was performed for the data that showed homogeneity. Categorical data are presented as relative risks and 95% confidence intervals (CIs), and measurement data are presented as weighted mean differences and 95%CIs.

Results: The incidence rates of severe pancreatitis, operation failure, complications and patient pain severity were analyzed. Data on pancreatitis incidence were reported in 14 of 15 trials. There was no significant heterogeneity between the trials (I(2) = 0%, P = 0.93). In the stent group, 49 of the 1233 patients suffered from PEP, compared to 133 of the 1277 patients in the no-stent group. The results of this meta-analysis indicate that it may be possible to prevent PEP by placing a PD stent.

Conclusion: PD stent placement can reduce postoperative hyperamylasemia and might be an effective and safe option to prevent PEP if the operation indications are well controlled.

Keywords: Endoscopic retrograde cholangiopancreatography; Pancreatic stent placement; Pancreatitis; Post-endoscopic retrograde cholangiopancreatography pancreatitis.

Figures

Figure 1

Publication retrieval flow chart. A flow chart depicting the step-by-step search process with respect to the eligibility criteria and the retrieval of published literature of the randomized controlled trials.

Figure 2

Forest plots. A: A forest plot depicting the incidence of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) in the analyzed studies; data from both articles and abstracts were included; B: A forest plot depicting the incidence of PEP in the analyzed studies; data from the abstracts were excluded.

Figure 3

Publication bias funnel plot. A funnel plot depicting the assessment of publication bias of the eligible studies included in this meta-analysis.