Elsevier

Gastrointestinal Endoscopy

Volume 73, Issue 2, February 2011, Pages 275-282
Gastrointestinal Endoscopy

Original article
Clinical endoscopy
Pancreatic stents for prophylaxis against post-ERCP pancreatitis: a meta-analysis and systematic review

https://doi.org/10.1016/j.gie.2010.10.039Get rights and content

Background

Acute pancreatitis is a common complication of ERCP. Several randomized, controlled trials (RCTs) have evaluated the use of pancreatic stents in the prevention of post-ERCP pancreatitis with varying results.

Objective

We conducted a meta-analysis and systematic review to assess the role of prophylactic pancreatic stents for prevention of post-ERCP pancreatitis.

Design

MEDLINE, Cochrane Central Register of Controlled Trials and Database of Systematic Reviews, PubMed, and recent abstracts from major conference proceedings were searched. RCTs and retrospective or prospective, nonrandomized studies comparing prophylactic stent with placebo or no stent for post-ERCP pancreatitis were included for the meta-analysis and systematic review. Standard forms were used to extract data by 2 independent reviewers. The effect of stents (for RCTs) was analyzed by calculating pooled estimates of post-ERCP pancreatitis, hyperamylasemia, and grade of pancreatitis. Separate analyses were performed for each outcome by using the odds ratio (OR) or weighted mean difference. Random- or fixed-effects models were used. Publication bias was assessed by funnel plots. Heterogeneity among studies was assessed by calculating I2 measure of inconsistency.

Setting

Systematic review and meta-analysis of patients undergoing pancreatic stent placement for prophylaxis against post-ERCP pancreatitis.

Patients

Adult patients undergoing ERCP.

Interventions

Pancreatic stent placement for the prevention of post-ERCP pancreatitis.

Main Outcome Measurements

Post-ERCP pancreatitis, hyperamylasemia, and complications after pancreatic stent placement.

Results

Eight RCTs (656 subjects) and 10 nonrandomized studies met the inclusion criteria (4904 subjects). Meta-analysis of the RCTs showed that prophylactic pancreatic stents decreased the odds of post-ERCP pancreatitis (odds ratio, 0.22; 95% CI, 0.12-0.38; P < .01). The absolute risk difference was 13.3% (95% CI, 8.8%-17.8%). The number needed to treat was 8 (95% CI, 6-11). Stents also decreased the level of hyperamylasemia (WMD, −309.22; 95% CI, −350.95 to −267.49; P ≤ .01). Similar findings were also noted from the nonrandomized studies.

Limitations

Small sample size of some trials, different types of stents used, inclusion of low-risk patients in some studies, and lack of adequate study of long-term complications of pancreatic stent placement.

Conclusions

Pancreatic stent placement decreases the risk of post-ERCP pancreatitis and hyperamylasemia in high-risk patients.

Section snippets

Study selection

Articles and abstracts comparing pancreatic stents with placebo or no treatment were selected. Exclusion criteria were those studies not involving post-ERCP pancreatitis as a study endpoint or studies comparing stents with other drugs or other stents or drains. The search was restricted to adult patients. There were no language restrictions. Both full-length publications and abstract publications were selected.

Literature search and identification of primary studies

Articles were searched on pancreatic stent placement in the prevention of post-ERCP

Meta-analysis of RCTs

The initial search identified 388 articles. Of these, 87 relevant articles were selected and reviewed by 3 independent authors (A.C., M.L.B., P.K.R.). Eight RCTs (656 subjects) and 10 nonrandomized studies (4904 subjects) met the inclusion criteria and were selected for final review and analysis (Fig. 1). Both the RCTs and nonrandomized studies were analyzed separately. Analysis of the RCTs is presented first. Table 1 shows the details and Jadad scores for the selected RCTs (5 = excellent

Discussion

Our meta-analysis and systematic review demonstrated that pancreatic stent placement after ERCP significantly decreased the odds of post-ERCP pancreatitis. Pancreatic stents lowered the risk of both mild and moderate post-ERCP pancreatitis. In the studies analyzed, the number of patients with severe pancreatitis was also lower those who had pancreatic stents. Our findings are similar to the 2 previous meta-analyses published on this topic.10, 14 The previous meta-analyses included 5 studies10

Acknowledgments

We thank Dr Thomas Whigham for his assistance during the preparation of the manuscript.

References (32)

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DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.

See CME section; p. 345

If you would like to chat with an author of this article, you may contact Dr Roy at [email protected].

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