Original Article
Does prophylactic pancreatic stent placement reduce the risk of post-ERCP acute pancreatitis? A meta-analysis of controlled trials

https://doi.org/10.1016/S0016-5107(04)02013-9Get rights and content

Background

Impaired drainage of the pancreatic duct is one of the possible triggers for post-ERCP acute pancreatitis. The aim of this meta-analysis was to determine whether temporary stent placement across the main pancreatic-duct orifice lowers the frequency of post-ERCP acute pancreatitis in patients at high risk for this complication.

Methods

Two reviewers systematically identified prospective studies that (1) compared the risk of post-ERCP acute pancreatitis in patients with pancreatic stent placement vs. no stent placement and (2) included patients at high risk of developing this complication. Studies were assessed for methodologic quality and variations in execution and design. Frequency and severity of post-ERCP acute pancreatitis were the primary outcomes evaluated.

Results

Five trials involving 481 patients were selected. Of the 481, 55 (11.4%) patients developed pancreatitis after ERCP. Patients in the no stent group had 3-fold higher odds of developing pancreatitis compared with the stent group (15.5% vs. 5.8%; OR 3.2: 95% CI[1.6, 6.4]). Number needed to treat analysis showed that one in every 10 patients (95% CI[6,18]) could be expected to benefit from pancreatic-duct stent placement.

Conclusions

Prophylactic temporary stent placement across the main pancreatic-duct orifice reduces the risk of post-ERCP acute pancreatitis in patients at risk for developing this complication.

Section snippets

Materials and methods

Systematic methods were used to identify all relevant studies, to assess studies for eligibility, to describe variations in study design and execution, and to evaluate study quality.12

Study identification and selection

The search identified 26 potentially relevant studies. After scanning titles and abstracts, 18 studies were excluded. Studies that were excluded either did not have a control group, included patients with chronic pancreatitis, or compared pancreaticobiliary sphincterotomy vs. biliary sphincterotomy alone. Five studies published in peer-reviewed journals and 3 abstracts were retained for further evaluation.7., 8., 9., 10., 11., 17., 18., 19. One article was excluded because of retrospective data

Discussion

This meta-analysis shows that prophylactic pancreatic stent placement reduces the rate of post-ERCP acute pancreatitis in patients at high risk for this complication. There was a significant reduction in the frequency of mild acute pancreatitis and a trend toward reduction in severe acute pancreatitis. Pancreatic stent placement had a low complication rate and a high success rate (>88%), which suggests that it is technically safe and not difficult in experienced hands.

Acute pancreatitis is the

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    Amitabh Chak is supported by a Midcareer Investigator Award in Patient Oriented Research from the National Institute of Health.

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