Pancreatic duct stents in the prophylaxis of pancreatic damage after endoscopic retrograde cholangiopancreatography: A systematic analysis of benefits and associated risks

Angelo Andriulli, Rosario Forlano, Grazia Napolitano, Pasquale Conoscitore, Nazario Caruso, Alberto Pilotto, Pier Luigi Di Sebastiano, Gioacchino Leandro

Research output: Contribution to journalArticle

Abstract

Methods: The efficacy of pancreatic stenting in the prevention of pancreatitis following endoscopic retrograde cholangiopancreatography (ERCP) was evaluated by a meta-analysis of 6 controlled studies; 12 additional uncontrolled studies were analyzed for rates of associated risk. Results: Post-ERCP pancreatitis (PEP) developed in 16.5% of controls, and in 5.1 or 9.6% of the stent group at the per-protocol (PP) or intention-to-treat (ITT) analyses. By analyzing only the 4 randomized trials, PEP developed in 24.1% of controls, and in 6.1 or 12.0% of the stented patients at the PP or ITT analyses. Risk was significantly lower in the stent group when compared with controls: OR 0.44 (95% CI 0.24-0.81). The absolute risk reduction is 12.0 (95% CI 3.0-21.0), the number needed to treat 8 (95% CI 5-34), and the publication bias 2. ORs for mild to moderate PEP were reduced in the stent group (OR = 0.537, 95% CI 0.283-1.021), as were those for severe PEP (OR = 0.123, 95% CI 0.021-0.726). Non-pancreatic complications were 4.2%, and included early stent migration (1.4%), perforations (0.4%), bleeding (1.4%), and infections (1.0%). Conclusion: Available trials show benefit for pancreatic stenting in the prophylaxis of PEP, but more randomized studies are needed before endorsing a routine use of this endoscopic procedure.

Original languageEnglish
Pages (from-to)156-163
Number of pages8
JournalDigestion
Volume75
Issue number2-3
DOIs
Publication statusPublished - Aug 2007

Keywords

  • Endoscopic retrograde cholangiopancreatography
  • Pancreatic stents
  • Pancreatitis, acute
  • Prophylaxis

ASJC Scopus subject areas

  • Gastroenterology

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