Meta-Analysis
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 28, 2015; 21(24): 7577-7583
Published online Jun 28, 2015. doi: 10.3748/wjg.v21.i24.7577
Updated meta-analysis of pancreatic stent placement in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis
Jin-He Fan, Jun-Bo Qian, Ya-Min Wang, Rui-Hua Shi, Cheng-Jin Zhao
Jin-He Fan, Jun-Bo Qian, Ya-Min Wang, Cheng-Jin Zhao, Department of Gastroenterology, Nantong First People’s Hospital, Nantong 226001, Jiangsu Province, China
Rui-Hua Shi, Department of Gastroenterology, People’s Hospital of Jiangsu Province, Nanjing 210029, Jiangsu Province, China
Author contributions: Fan JH carried out the studies, participated in collecting data, and drafted the manuscript; Qian JB performed the statistical analysis and participated in study design; Wang YM, Shi RH and Zhao CJ helped to draft the manuscript; all authors read and approved the final manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jun-Bo Qian, MD, Department of Gastroenterology, Nantong First People’s Hospital, No. 6 North Haier Gang, Nantong 226001, Jiangsu Province, China. medscifjh@126.com
Telephone: +86-21-85061285 Fax: +86-21-64085875
Received: May 29, 2014
Peer-review started: May 30, 2014
First decision: June 18, 2014
Revised: September 19, 2014
Accepted: January 21, 2015
Article in press: January 22, 2015
Published online: June 28, 2015
Processing time: 395 Days and 22.5 Hours
Abstract

AIM: To investigate the efficacy and safety profile of pancreatic duct (PD) stent placement for prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP).

METHODS: We performed a search of MEDLINE, EMBASE, and Cochrane Library to identify randomized controlled clinical trials of prophylactic PD stent placement after ERCP. RevMan 5 software provided by Cochrane was used for the heterogeneity and efficacy analyses, and a meta-analysis was performed for the data that showed homogeneity. Categorical data are presented as relative risks and 95% confidence intervals (CIs), and measurement data are presented as weighted mean differences and 95%CIs.

RESULTS: The incidence rates of severe pancreatitis, operation failure, complications and patient pain severity were analyzed. Data on pancreatitis incidence were reported in 14 of 15 trials. There was no significant heterogeneity between the trials (I2 = 0%, P = 0.93). In the stent group, 49 of the 1233 patients suffered from PEP, compared to 133 of the 1277 patients in the no-stent group. The results of this meta-analysis indicate that it may be possible to prevent PEP by placing a PD stent.

CONCLUSION: PD stent placement can reduce postoperative hyperamylasemia and might be an effective and safe option to prevent PEP if the operation indications are well controlled.

Keywords: Pancreatic stent placement; Pancreatitis; Endoscopic retrograde cholangiopancreatography; Post-endoscopic retrograde cholangiopancreatography pancreatitis

Core tip: Pancreatitis is one of the most common and severe complications after endoscopic retrograde cholangiopancreatography (ERCP). The reported incidence of post-ERCP pancreatitis (PEP) varies between 2% and 7% in prospective trials and may be as high as 30%-50% in high-risk patients. Although a previous meta-analysis has indicated that pancreatic duct stent placement can prevent PEP, particularly in high-risk patients, there is a lack of high-quality evidence-based studies based on appropriate numbers of well-validated publications. Therefore, an updated meta-analysis was conducted to investigate stents in preventing PEP.