Online citations, reference lists, and bibliographies.
← Back to Search

Does Prophylactic Pancreatic Stent Placement Reduce The Risk Of Post-ERCP Acute Pancreatitis? A Meta-analysis Of Controlled Trials.

P. Singh, A. Das, G. Isenberg, R. Wong, M. Sivak, D. Agrawal, A. Chak
Published 2004 · Medicine

Cite This
Download PDF
Analyze on Scholarcy
Share
BACKGROUND Impaired drainage of the pancreatic duct is one of the possible triggers for post-ERCP acute pancreatitis. The aim of this meta-analysis was to determine whether temporary stent placement across the main pancreatic-duct orifice lowers the frequency of post-ERCP acute pancreatitis in patients at high risk for this complication. METHODS Two reviewers systematically identified prospective studies that (1) compared the risk of post-ERCP acute pancreatitis in patients with pancreatic stent placement vs. no stent placement and (2) included patients at high risk of developing this complication. Studies were assessed for methodologic quality and variations in execution and design. Frequency and severity of post-ERCP acute pancreatitis were the primary outcomes evaluated. RESULTS Five trials involving 481 patients were selected. Of the 481, 55 (11.4%) patients developed pancreatitis after ERCP. Patients in the no stent group had 3-fold higher odds of developing pancreatitis compared with the stent group (15.5% vs. 5.8%; OR 3.2: 95% CI[1.6, 6.4]). Number needed to treat analysis showed that one in every 10 patients (95% CI[6,18]) could be expected to benefit from pancreatic-duct stent placement. CONCLUSIONS Prophylactic temporary stent placement across the main pancreatic-duct orifice reduces the risk of post-ERCP acute pancreatitis in patients at risk for developing this complication.
This paper references
10.2307/2531052
Estimators of the Mantel-Haenszel variance consistent in both sparse data and large-strata limiting models.
J. Robins (1986)
10.1016/0016-5085(91)90735-4
Complications of endoscopic sphincterotomy. A prospective series with emphasis on the increased risk associated with sphincter of Oddi dysfunction and nondilated bile ducts.
S. Sherman (1991)
10.1001/JAMA.273.5.408
Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials.
K. Schulz (1995)
10.1067/MGE.2003.124
Does a pancreatic duct stent prevent post-ERCP pancreatitis? A prospective randomized study.
A. Fazel (2003)
10.7326/0003-4819-127-7-199710010-00005
Selecting and Appraising Studies for a Systematic Review
M. Meade (1997)
10.1055/S-2002-23629
Sphincter of Oddi dysfunction: pancreaticobiliary sphincterotomy with pancreatic stent placement has a lower rate of pancreatitis than biliary sphincterotomy alone.
E. Fogel (2002)
10.1016/S0016-5107(93)70217-5
Effect of prophylactic main pancreatic duct stenting on the incidence of biliary endoscopic sphincterotomy-induced pancreatitis in high-risk patients.
A. Smithline (1993)
10.1016/S0016-5107(96)70163-3
Alterations in pancreatic ductal morphology following polyethylene pancreatic stent therapy.
M. Smith (1996)
10.1067/MGE.2001.115730
Stent placement in the pancreatic duct prevents pancreatitis after endoscopic sphincter dilation for removal of bile duct stones.
T. Aizawa (2001)
MEDLINE search strategy
R. Gray (1999)
10.1016/S0016-5107(96)70164-5
Stent-induced pancreatic ductal and parenchymal changes: correlation of endoscopic ultrasound with ERCP.
S. Sherman (1996)
10.1016/0197-2456(86)90046-2
Meta-analysis in clinical trials.
R. Dersimonian (1986)
10.1016/S0016-5107(02)70025-4
Adverse outcomes of ERCP.
M. Freeman (2002)
10.1016/S0016-5085(98)70031-9
Pancreatic stenting prevents pancreatitis after biliary sphincterotomy in patients with sphincter of Oddi dysfunction.
P. Tarnasky (1998)
10.1056/NEJM199609263351301
Complications of endoscopic biliary sphincterotomy.
M. Freeman (1996)
10.1097/00006676-199105000-00013
ERCP‐ and Endoscopic Sphincterotomy‐Induced Pancreatitis
S. Sherman (1991)
10.1016/S0002-9270(00)02387-X
Complications of diagnostic and therapeutic ERCP: a prospective multicenter study.
E. Masci (2001)
10.1016/S0016-5085(98)81956-2
Pancreatic duct stenting decreases the incidence of post-ERCP pancreatitis: A prospective randomized study
S. Meyerson (1998)
10.1067/MGE.2001.117550
Risk factors for post-ERCP pancreatitis: a prospective, multicenter study.
M. Freeman (2001)
10.1016/S0016-5107(91)70740-2
Endoscopic sphincterotomy complications and their management: an attempt at consensus.
P. Cotton (1991)
10.1055/S-2007-1018177
Balloon dilation of the sphincter of Oddi.
R. Kozarek (1988)



This paper is referenced by
10.1016/J.GIE.2005.12.033
The role of ERCP in patients with pancreatico-biliary problems in the setting of hematopoietic stem cell transplant.
M. M. Alnusair (2006)
10.1016/j.gie.2015.06.027
The role of endoscopy in ampullary and duodenal adenomas.
K. Chathadi (2015)
10.1016/J.CGH.2007.09.007
Pancreatic stents for prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis.
M. Freeman (2007)
10.1016/j.giec.2011.04.011
Pancreatic stents.
J. Deviére (2011)
10.1080/00365520510015412
Sphincter of Oddi – still mysterious, still complicated
P. Rolny (2005)
10.1038/ajg.2009.269
Can a Wire-Guided Cannulation Technique Increase Bile Duct Cannulation Rate and Prevent Post-ERCP Pancreatitis?: A Meta-Analysis of Randomized Controlled Trials
V. Cennamo (2009)
10.1136/gut.2008.155788
Subdividing functional dyspepsia: a paradigm shift?
N. Talley (2008)
10.1177/2050640618804729
Modified prophylactic 5-fr pancreatic duct stent enhances the rate of spontaneous dislodgement: A multicenter randomized controlled trial
Q. He (2018)
10.1016/J.GIE.2007.02.001
ERCP and prophylactic pancreatic stents: raising the bar, reducing the pain.
W. Silverman (2007)
10.1097/MCG.0000000000000397
Prophylactic Efficacy of 3- or 5-cm Pancreatic Stents for Preventing Post-ERCP Pancreatitis: A Prospective, Randomized Trial
T. Fujisawa (2016)
10.1055/s-0034-1377875
Prophylaxis of post-ERCP pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - updated June 2014.
J. Dumonceau (2014)
10.1007/s10620-011-1695-x
Prophylactic Pancreatic Stents: Does Size Matter? A Comparison of 4-Fr and 5-Fr Stents in Reference to Post-ERCP Pancreatitis and Migration Rate
Albert Pahk (2011)
10.1016/B978-0-323-34062-5.00020-0
Chapter 20 – Direct cholangiography: Approaches, techniques, and current role
Robert H. Siegelbaum (2017)
10.1136/gutjnl-2012-302514c.207
PTU-207 Detection of dysplasia arising in Barrett's oesophagus is associated with better quality endoscopic technique
J. Dunn (2012)
10.1007/s00464-012-2487-x
Pancreatic duct stenting for the duration of ERCP only does not prevent pancreatitis after accidental pancreatic duct cannulation: a prospective randomized trial
R. Conigliaro (2012)
10.1590/S0004-2803.202000000-55
ENDOSCOPIC PAPILLECTOMY FOR EARLY AMPULLARY NEOPLASTIC LESIONS - A CASE SERIES ANALYSIS.
Nelson Silveira Cathcart (2020)
10.1097/01.EBG.0000202910.35443.82
Refining the ampullectomy technique: Commentary
I. Grimm (2006)
10.1097/MPA.0b013e3181bb8da1
Nonprevention of Post-Endoscopic Retrograde Cholangiopancreatographic Pancreatitis by Pancreatic Stent After Aspiration of Pure Pancreatic Juice in Patients With Intraductal Papillary Mucinous Neoplasms of the Pancreas
R. Harada (2010)
10.1097/MPA.0000000000000246
Incidence of Post-ERCP Pancreatitis From Direct Pancreatic Juice Collection in Hereditary Pancreatitis and Familial Pancreatic Cancer Before and After the Introduction of Prophylactic Pancreatic Stents and Rectal Diclofenac
J. A. Nicholson (2015)
10.1056/NEJMc1205928
Rectal indomethacin to prevent post-ERCP pancreatitis.
T. Baron (2012)
10.1007/978-3-540-93842-2_40
Endoscopic Retrograde and Percutaneous Transhepatic Cholangiography
Henryk Dancygier (2010)
10.1016/j.gie.2007.07.037
Temporary prophylactic pancreatic stents: which patients need them?
G. Elta (2008)
Endoscopic Papillectomy into the Treatment of Neoplastic Lesions of Vater Papilla
G. Ghidirim (2009)
10.3748/wjg.v17.i15.1989
Pancreatic duct guidewire placement for biliary cannulation in a single-session therapeutic ERCP.
D. Xinopoulos (2011)
10.3748/wjg.v21.i30.9182
0.025-inch vs 0.035-inch guide wires for wire-guided cannulation during endoscopic retrograde cholangiopancreatography: A randomized study.
K. Kitamura (2015)
10.1016/J.TGIE.2012.06.001
Complications of endoscopic retrograde cholangiopancreatography
M. Freeman (2012)
10.1053/j.gastro.2016.04.048
Rectal Indomethacin Reduces Pancreatitis in High- and Low-Risk Patients Undergoing Endoscopic Retrograde Cholangiopancreatography.
N. Thiruvengadam (2016)
10.1016/J.GIE.2007.06.022
Pancreatic duct stent placement prevents post-ERCP pancreatitis in patients with suspected sphincter of Oddi dysfunction but normal manometry results.
A. M. Saad (2008)
Esdeveniments adversos posteriors a la colangiopancreatografia retrograda endoscòpica en els pacients amb cirrosi hepàtica i en els receptors de transplantament hepàtic
Carles Leal i Valdivieso (2019)
10.1055/s-0029-1215374
Frequency of sphincter of Oddi dysfunction in patients with previously normal sphincter of Oddi manometry studies.
M. Khashab (2010)
Avoidance and Management
M. Freeman (2012)
10.1007/s00535-012-0707-8
Comparison of long-term outcomes after endoscopic sphincterotomy versus endoscopic papillary balloon dilation: a propensity score-based cohort analysis
S. Doi (2012)
See more
Semantic Scholar Logo Some data provided by SemanticScholar