November 12, 2014
Notes: Mayerle, Julia
Lerch, Markus M
Dtsch Arztebl Int. 2013 May;110(22):387-93. doi: 10.3238/arztebl.2013.0387. Epub 2013 May 31.
Author Address: University Medicine Greifswald, Department of Internal Medicine A.
Reference Type: Journal Article
Record Number: 5300Author: Mazaki, T., Mado, K., Masuda, H. and Shiono, M.
Title: Prophylactic pancreatic stent placement and post-ERCP pancreatitis: an updated meta-analysis
Journal: J Gastroenterol
Short Title: Prophylactic pancreatic stent placement and post-ERCP pancreatitis: an updated meta-analysis
Alternate Journal: Journal of gastroenterology
ISSN: 1435-5922 (Electronic)
Accession Number: 23612857
Abstract: BACKGROUND AND AIM: Pancreatitis is one of the most frequent post-endoscopic retrograde cholangiopancreatography (ERCP) complications. Previous meta-analyses show that prophylactic pancreatic stent (PS) placement after ERCP is beneficial for the prevention of post-ERCP pancreatitis (PEP). However, the results of these meta-analyses are controversial due to the limited sample size of the eligible studies, in which six additional randomized controlled trials (RCTs) are not included. Our aim is, therefore, to update the current meta-analyses regarding PS placement for prevention of PEP. METHODS: We conducted a meta-analysis to identify RCTs comparing PS placement and the subsequent incidence of PEP. The primary outcome was the incidence of PEP. RESULTS: Fourteen studies were enrolled in this meta-analysis. Of the 1,541 patients, 760 patients received a PS and 781 patients were allocated to the control group. PS placement was associated with a statistically significant reduction of PEP [relative risk (RR) 0.39; 95 % confidence interval (CI) 0.29-0.53; P < 0.001]. Subgroup analysis stratified according to the severity of PEP showed that a PS was beneficial in patients with mild to moderate PEP (RR 0.45; 95 % CI 0.32-0.62; P < 0.001) and in patients with severe PEP (RR 0.26; 95 %CI 0.09-0.76; P = 0.01). In addition, subgroup analysis performed according to patient selection demonstrated that PS placement was effective for both high-risk and mixed case groups. CONCLUSIONS: This meta-analysis showed that PS placement prevented PEP after ERCP as compared with no PS placement. We therefore recommend PS placement after ERCP for the prevention of PEP.