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Prophylactic pancreatic stent placement and post-ERCP pancreatitis: an updated meta-analysis

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
Journal of Gastroenterology Aims and scope Submit manuscript

An Editorial to this article was published on 10 September 2013

Abstract

Background and aim

Pancreatitis is one of the most frequent post-endoscopic retrograde cholangiopancreatography (ERCP) complications. Previous meta-analyses show that prophylactic pancreatic stent (PS) placement after ERCP is beneficial for the prevention of post-ERCP pancreatitis (PEP). However, the results of these meta-analyses are controversial due to the limited sample size of the eligible studies, in which six additional randomized controlled trials (RCTs) are not included. Our aim is, therefore, to update the current meta-analyses regarding PS placement for prevention of PEP.

Methods

We conducted a meta-analysis to identify RCTs comparing PS placement and the subsequent incidence of PEP. The primary outcome was the incidence of PEP.

Results

Fourteen studies were enrolled in this meta-analysis. Of the 1,541 patients, 760 patients received a PS and 781 patients were allocated to the control group. PS placement was associated with a statistically significant reduction of PEP [relative risk (RR) 0.39; 95 % confidence interval (CI) 0.29–0.53; P < 0.001]. Subgroup analysis stratified according to the severity of PEP showed that a PS was beneficial in patients with mild to moderate PEP (RR 0.45; 95 % CI 0.32–0.62; P < 0.001) and in patients with severe PEP (RR 0.26; 95 %CI 0.09–0.76; P = 0.01). In addition, subgroup analysis performed according to patient selection demonstrated that PS placement was effective for both high-risk and mixed case groups.

Conclusions

This meta-analysis showed that PS placement prevented PEP after ERCP as compared with no PS placement. We therefore recommend PS placement after ERCP for the prevention of PEP.

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Abbreviations

D + L:

DerSimonian and Laird

ERCP:

Endoscopic retrograde cholangiopancreatography

I-V:

Inverse-variance

NSAIDs:

Non-steroidal anti-inflammatory drugs

PS:

Pancreatic stent

PEP:

Post-ERCP pancreatitis

SOD:

Sphincter of Oddi dysfunction

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The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Surgery, Nihon University School of Medicine, 30-1 Oyaguchikami-machi, Itabashi-ku, Tokyo, 173-8610, Japan

    Takero Mazaki, Kazunari Mado, Hideki Masuda & Motomi Shiono

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  1. Takero Mazaki
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Correspondence to Takero Mazaki.

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Mazaki, T., Mado, K., Masuda, H. et al. Prophylactic pancreatic stent placement and post-ERCP pancreatitis: an updated meta-analysis. J Gastroenterol 49, 343–355 (2014). https://doi.org/10.1007/s00535-013-0806-1

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