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


CONCLUSIONS
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.
Division of Gastroenterology, Casa Sollievo della Sofferenza Hospital, IRCCS, San Giovanni Rotondo, Italy. a.andriulli@operapadrepio.it
Angelo
A
Andriulli
Rosario
R
Forlano
Grazia
G
Napolitano
Pasquale
P
Conoscitore
Nazario
N
Caruso
Alberto
A
Pilotto
Pier Luigi
PL
Di Sebastiano
Gioacchino
G
Leandro
D000208:Acute Disease; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D002986:Clinical Trials as Topic; D003627:Data Interpretation, Statistical; D006801:Humans; D010195:Pancreatitis / Q000209:etiology* / Q000517:prevention & control*; D011183:Postoperative Complications; D012307:Risk Factors; D015607:Stents