Prophylactic pancreatic stent placement and post-ERCP pancreatitis: a systematic review and meta-analysis

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.