Published online Jun 14, 2014. doi: 10.3748/wjg.v20.i22.7040
Revised: January 10, 2014
Accepted: March 5, 2014
Published online: June 14, 2014
AIM: To assess the effectiveness of pancreatic stents for preventing pancreatitis in high-risk patients after endoscopic retrograde cholangiopancreatography (ERCP).
METHODS: PubMed, Embase, Science Citation Index, and Cochrane Controlled Trials Register were searched to identify relevant trials published in English. Inclusion and exclusion criteria were used to screen for suitable studies. Two reviewers independently judged the study eligibility while screening the citations. The methodological quality of the included trials was assessed using the Jadad scoring system. All results were expressed as OR and 95%CI. Data were analyzed using Stata12.0 software.
RESULTS: Ten eligible randomized controlled trials were selected, including 1176 patients. A fixed-effects model in meta-analysis supported that pancreatic duct stents significantly decreased the incidence of post-ERCP pancreatitis (PEP) in high-risk patients (OR = 0.25; 95%CI: 0.17-0.38; P < 0.001). Pancreatic stents also alleviated the severity of PEP (mild pancreatitis after ERCP: OR = 0.33; 95%CI: 0.21-0.54; P < 0.001; moderate pancreatitis after ERCP: OR = 0.30; 95%CI: 0.13-0.67; P = 0.004). The result of severe pancreatitis after ERCP was handled more rigorously (OR = 0.24; 95%CI: 0.05-1.16; P = 0.077). Serum amylase levels were not different between patients with pancreatic stents and control patients (OR = 1.08; 95%CI: 0.82-1.41; P = 0.586).
CONCLUSION: Placement of prophylactic pancreatic stents may lower the incidence of post-ERCP pancreatitis in high-risk patients and alleviate the severity of this condition.
Core tip: Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis is the most common and serious complication of ERCP. In the past few decades, a number of clinical randomized controlled trials have shown that pancreatic stents can effectively prevent the occurrence of post-ERCP pancreatitis (PEP). In view of these high quality data, we conducted this meta-analysis to evaluate the effectiveness of pancreatic stent placement in preventing PEP in high-risk patients. Our results supported that pancreatic stent placement is an effective means to prevent PEP and alleviate the severity (mild and moderate) of PEP in high-risk patients. Furthermore, no serious complications were reported in subjects in the stent group.