Does prophylactic pancreatic stent placement reduce the risk of post-ERCP acute pancreatitis? A meta-analysis of controlled trials.
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.
Division of Gastroenterology, Department of Internal Medicine, University Hospitals of Cleveland, Ohio, USA.
Pankaj
P
Singh
Ananya
A
Das
Gerard
G
Isenberg
Richard C K
RC
Wong
Michael V
MV
Sivak
Deepak
D
Agrawal
Amitabh
A
Chak
D000208:Acute Disease; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002986:Clinical Trials as Topic; D006801:Humans; D010195:Pancreatitis / Q000517:prevention & control*; D011183:Postoperative Complications; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D015607:Stents