title: Comparison of postoperative complications between internal and external pancreatic duct stenting during pancreaticoduodenectomy: a meta-analysis.
abstract: BACKGROUND
  Two types of pancreatic duct stents are used to improve postoperative outcomes of pancreatic anastomosis. The aim of this meta-analysis was to evaluate and compare the postoperative outcomes of patients with internal or external stenting during pancreaticoduodenectomy (PD).
  
  
  METHODS
  We searched PubMed, EMBASE, the Cochrane Library and Web of Science databases until the end of December, 2014. Studies comparing outcomes of external vs. internal stent placement in PD were eligible for inclusion. Included literature was extracted and assessed by two independent reviewers.
  
  
  RESULTS
  Seven articles were identified for inclusion: three randomized controlled trials (RCTs) and four observational clinical studies (OCS). The meta-analyses revealed that use of external stents had advantage on reducing the incidences of pancreatic fistula (PF) in total [odds ratio (OR) =0.69; 95% confidence interval (CI), 0.48-0.99; P=0.04], PF in soft pancreas (OR =0.30; 95% CI, 0.16-0.56; P=0.0002) and delayed gastric emptying (DGE) (OR =0.58; 95% CI, 0.38-0.89; P=0.01) compared with internal stents. There were no significant differences in other postoperative outcomes between two stenting methods, including postoperative morbidity (OR =0.93; 95% CI, 0.39-2.23; P=0.88), overall mortality (OR =0.70; 95% CI, 0.22-2.25; P=0.55), and intra-abdominal collections (OR =0.67; 95% CI, 0.26-1.71; P=0.40).
  
  
  CONCLUSIONS
  Based upon this meta-analysis, the use of external pancreatic stents might have potential benefit in reducing the incidence of PF and DGE. Due to the limited number of original studies, more RCTs are needed to further support our result and clarify the issue.
authors.affiliation: 1 Department of General Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China ; 2 Department of Hepatobiliary and Pancreatic Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Fa-Yong
authors.initials: FY
authors.lastname: Ke
authors.affiliation: 1 Department of General Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China ; 2 Department of Hepatobiliary and Pancreatic Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Xiang-Song
authors.initials: XS
authors.lastname: Wu
authors.affiliation: 1 Department of General Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China ; 2 Department of Hepatobiliary and Pancreatic Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Yong
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: 1 Department of General Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China ; 2 Department of Hepatobiliary and Pancreatic Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Hong-Cheng
authors.initials: HC
authors.lastname: Zhang
authors.affiliation: 1 Department of General Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China ; 2 Department of Hepatobiliary and Pancreatic Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Ming-Zhe
authors.initials: MZ
authors.lastname: Weng
authors.affiliation: 1 Department of General Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China ; 2 Department of Hepatobiliary and Pancreatic Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Ying-Bin
authors.initials: YB
authors.lastname: Liu
authors.affiliation: 1 Department of General Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China ; 2 Department of Hepatobiliary and Pancreatic Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Wolfgang
authors.affiliation: 1 Department of General Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China ; 2 Department of Hepatobiliary and Pancreatic Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Wei
authors.initials: W
authors.lastname: Gong
keywords: Pancreatic duct stent; meta-analysis; pancreaticoduodenectomy (PD)