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Prophylactic pancreatic stent placement and post-ERCP pancreatitis: a systematic review and meta-analysis.
Endoscopy 2010; 42(10):842-53E

Abstract

BACKGROUND AND STUDY AIMS

Pancreatitis is one of the most frequent complications of endoscopic retrograde cholangiopancreatography (ERCP). The placement of a prophylactic pancreatic stent after ERCP can help prevent post-ERCP pancreatitis (PEP). We aimed to provide an up-to-date meta-analysis regarding pancreatic stent placement for prevention of PEP and review the immediate adverse events associated with pancreatic stent placement.

METHODS

We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) considering pancreatic stent placement and the subsequent incidence of PEP. The primary outcome measure was the incidence of PEP. We also did a meta-analysis of RCTs and observational studies that reported on immediate adverse events, in order to estimate their incidence.

RESULTS

Eight studies, involving 680 patients, were included in the meta-analysis; 336 patients had pancreatic stent placement, and 344 patients formed the control group. Pancreatic stent placement was associated with a statistically significant reduction in PEP (relative risk [RR] 0.32, 95 % confidence interval [CI] 0.19 - 0.52; P<0.001). Subgroup analysis with stratification according to PEP severity showed that pancreatic stenting was beneficial in patients with mild to moderate PEP (RR 0.36, 95 %CI 0.22 -0.60; P<0.001) and in patients with severe PEP (RR 0.23, 95 %CI 0.06 - 0.91; P=0.04). Subgroup analysis according to patient selection demonstrated that pancreatic stenting was effective for both high risk and mixed-case groups. Weighted pooled estimates from between one and 17 studies for incidences of immediate adverse events were: overall complications 4.4 %; any infection 3.0 %; bleeding 2.5 %; cholangitis or cholecystitis 3.1 %; necrosis 0.4 %; pancreatic stent migration 4.9 % and occlusion 7.9 %; perforation 0.8 %; pseudocysts 3.0 %; and retroperitoneal perforation 1.2 %.

CONCLUSIONS

The meta-analysis shows that pancreatic stent placement after ERCP reduces the risk of PEP.

Authors+Show Affiliations

Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, 2-11-1 Hikarigaoka, Nerima-ku, Tokyo, Japan. mazaki@med.nihon-u.ac.jpNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

20886403

Citation

Mazaki, T, et al. "Prophylactic Pancreatic Stent Placement and post-ERCP Pancreatitis: a Systematic Review and Meta-analysis." Endoscopy, vol. 42, no. 10, 2010, pp. 842-53.
Mazaki T, Masuda H, Takayama T. Prophylactic pancreatic stent placement and post-ERCP pancreatitis: a systematic review and meta-analysis. Endoscopy. 2010;42(10):842-53.
Mazaki, T., Masuda, H., & Takayama, T. (2010). Prophylactic pancreatic stent placement and post-ERCP pancreatitis: a systematic review and meta-analysis. Endoscopy, 42(10), pp. 842-53. doi:10.1055/s-0030-1255781.
Mazaki T, Masuda H, Takayama T. Prophylactic Pancreatic Stent Placement and post-ERCP Pancreatitis: a Systematic Review and Meta-analysis. Endoscopy. 2010;42(10):842-53. PubMed PMID: 20886403.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prophylactic pancreatic stent placement and post-ERCP pancreatitis: a systematic review and meta-analysis. AU - Mazaki,T, AU - Masuda,H, AU - Takayama,T, Y1 - 2010/09/30/ PY - 2010/10/2/entrez PY - 2010/10/5/pubmed PY - 2011/1/11/medline SP - 842 EP - 53 JF - Endoscopy JO - Endoscopy VL - 42 IS - 10 N2 - BACKGROUND AND STUDY AIMS: Pancreatitis is one of the most frequent complications of endoscopic retrograde cholangiopancreatography (ERCP). The placement of a prophylactic pancreatic stent after ERCP can help prevent post-ERCP pancreatitis (PEP). We aimed to provide an up-to-date meta-analysis regarding pancreatic stent placement for prevention of PEP and review the immediate adverse events associated with pancreatic stent placement. METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) considering pancreatic stent placement and the subsequent incidence of PEP. The primary outcome measure was the incidence of PEP. We also did a meta-analysis of RCTs and observational studies that reported on immediate adverse events, in order to estimate their incidence. RESULTS: Eight studies, involving 680 patients, were included in the meta-analysis; 336 patients had pancreatic stent placement, and 344 patients formed the control group. Pancreatic stent placement was associated with a statistically significant reduction in PEP (relative risk [RR] 0.32, 95 % confidence interval [CI] 0.19 - 0.52; P<0.001). Subgroup analysis with stratification according to PEP severity showed that pancreatic stenting was beneficial in patients with mild to moderate PEP (RR 0.36, 95 %CI 0.22 -0.60; P<0.001) and in patients with severe PEP (RR 0.23, 95 %CI 0.06 - 0.91; P=0.04). Subgroup analysis according to patient selection demonstrated that pancreatic stenting was effective for both high risk and mixed-case groups. Weighted pooled estimates from between one and 17 studies for incidences of immediate adverse events were: overall complications 4.4 %; any infection 3.0 %; bleeding 2.5 %; cholangitis or cholecystitis 3.1 %; necrosis 0.4 %; pancreatic stent migration 4.9 % and occlusion 7.9 %; perforation 0.8 %; pseudocysts 3.0 %; and retroperitoneal perforation 1.2 %. CONCLUSIONS: The meta-analysis shows that pancreatic stent placement after ERCP reduces the risk of PEP. SN - 1438-8812 UR - https://www.unboundmedicine.com/medline/citation/20886403/Prophylactic_pancreatic_stent_placement_and_post_ERCP_pancreatitis:_a_systematic_review_and_meta_analysis_ L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-0030-1255781 DB - PRIME DP - Unbound Medicine ER -