Prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis using pancreatic stents: A review of efficacy, diameter and length

Table 3 Comparison of stent type

Author, yr	Stent type	n	Results
Flanged or unflanged
He et al[39], 2018	Internal unflanged 5-Fr 3 cm stent with a single pigtail on the duodenal side vs internal flanged 5-Fr 3 cm stent with a single pigtail on the duodenal side	138/138	Spontaneous migration was more frequent with the internal unflanged stent (migration at five days: 47.72% vs 15.67%, P < 0.001, migration at 14 d 84.21% vs 42.65%, P < 0.001)
Comparison of stent diameter
Rashdan et al[40], 2004	3-4-Fr, 3-8 cm without internal flange vs 5-6-Fr, NA, with internal flange	2447/493	The 3-4-Fr stent was more effective in preventing PEP than the 5-6-Fr stent (PEP rate: 3-4-Fr stent 8.7% (213/2447) vs 5-6Fr 11.0% (54/493), P = 0.0471)
Zolotarevsky et al[43], 2011	5-Fr 5 cm vs 3-Fr 6 cm	38/40	PEP rates did not differ. 5-Fr PS placement was easier [mean modified 5-point Likert scale[40,41]: 1.8 (5-Fr) vs 3.4 (3-Fr), P < 0.01)], faster [9.2 (5-Fr) vs 11.1 minutes (3-Fr), P = 0.355], and required fewer wires [1.5 (5-Fr) vs 1.9 (6-Fr), P = 0.002]
Pahk et al[44], 2011	4-Fr vs 5-Fr, both stents were 2 to 11 cm, unflanged	137/209	PEP rates did not differ. Spontaneous migration was more frequent with the 4-Fr stent [95.8% (115/137) vs 68.7% (134/209), P < 0.001 (by log-rank test)]
Olsson et al[45], 2016	≤ 5-Fr, ≤ 5 cm vs > 5-Fr, > 5 cm	241 (≤ 5-Fr)/135 (> 5-Fr)	The > 5-Fr, > 5 cm stent was more effective in preventing PEP (> 5-Fr, > 5 cm 1.4% vs ≤ 5-Fr, ≤ 5 cm 9.4%, P = 0.0252)
Comparison of stent length
Chahal et al[46], 2009	5-Fr 3 cm, unflanged vs 3-Fr 8 cm or longer, unflanged	116/133	Spontaneous migration was more frequent with the 5-Fr 3 cm stent (5-Fr 98% vs 3-Fr 88%, P = 0.0001). Failure of PS placement was observed more often in the longer 3-Fr stent group (5-Fr 0/116 vs 3-Fr 11/133, P = 0.0003). PEP rates did not differ
Fujisawa et al[47], 2016	5-Fr 3 cm vs 5-Fr 5 cm, both stents were unflanged and straight	98/102	The 5-Fr 3 cm stent was more efficient for preventing PEP (3 cm 2.0% vs 5 cm 8.8%, P = 0.035). The period until spontaneous dislodgement was significantly shorter for the 3 cm stent than for the 5 cm stent (3 cm 2 d vs 5 cm 4 d, P < 0.001)
Part of the pancreas in which the stent was inserted
Sugimoto et al[48], 2018	Pancreatic head vs pancreatic body or tail	131/16	After ERCP, the level of the pancreatic isozyme of serum amylase was higher in the head group than in the body/tail group [head group 138.5 (7.0-2086) IU/L vs body/tail group 78.5 (5.0-1266.5) IU/L, P < 0.03]

ERCP: Endoscopic retrograde cholangiopancreatography; PEP: Post-ERCP pancreatitis.