Sa1525 Prophylactic Pancreatic Duct Stenting for Prevention of Post-ERCP Pancreatitis: an Updated Meta-Analysis

Prophylactic Pancreatic Duct Stenting for Prevention of PostERCP Pancreatitis: an Updated Meta-Analysis Anupama Inaganti*, Naga Swetha Samji, Rajan Kanth, Sarah D. Komanapalli, Mainor R. Antillon, Ramon E. Rivera, Praveen K. Roy Internal Medicine, Marshfield Clinic, Marshfield, WI; Gastroenterology and Hepatology, Ochsner Clinic, New Orleans, LA Background: Post ERCP acute pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). The efficacy of prophylactic pancreatic duct stent for prevention of post-ERCP pancreatitis (PEP) has been studied in several randomized controlled trials (RCTs). We conducted an updated meta-analysis to evaluate the efficacy and safety of prophylactic pancreatic duct stenting for the prevention of PEP. Methods: Pubmed, Embase, CINHAL, the Cochrane Library and abstracts from major conference proceedings were searched for relevant articles. RCTs assessing the efficacy of prophylactic pancreatic duct stenting with no stent in preventing post ERCP pancreatitis were included in the analysis. Data was extracted by two independent reviewers using standard forms. Data on patient demographics, indications, complications and characteristics of stents used was extracted for analysis. Pooled estimates of PEP, hyperamylasemia, and grade of pancreatitis were analyzed to evaluate the effect of stents. Separate analyses were performed for each outcome by using the risk ratio (RR) or weighted mean difference. Publication bias was assessed using funnel plots. Random effects models were used. Results: Thirteen RCTs met the inclusion criteria (1438 subjects). 6 studies were performed in the United States, 5 studies in Japan, 1 in South Korea and 1in China. 551 females were included from 8 studies. Mean age was 18-92 years. 12 studies included high risk group patients. 5 Fr stents were used in 11 studies, 3 Fr and 7 Fr stent in one study each. Unflanged stents were used in 5 studies. Shorter stents 3 cm were used in eight studies. Stent placement was successful in 88.3% to 100% of patients (3 studies). 6 of the studies used protease inhibitors. Meta-analysis of RCTs showed that prophylactic pancreatic stents reduced the risk of developing post ERCP pancreatitis RR 0.37 (95% CI 0.26-0.52, p 0.0001). The number needed to treat was 8. There was significant risk reduction in severe PEP RR 0.26 (95% CI 0.080.83, p 0.02) with pancreatic stents. Reduction in mild pancreatitis RR 0.502 (95% CI 0.341-0.502, p-value 0.001) and moderate pancreatitis RR 0.346 (95% CI 0.169-0.709, p 0.004) was also noted. No significant decrease in hyperamylasemia was noted (weighted mean difference -294.488, 95% CI 11.3600.3, p 0.06). Stents were left in place for 3-7 days and spontaneous dislodgement rate was 90% to 96.7%. Mean duration of dislodgement was 2-3.5 days (5 studies). Conclusion: Pancreatic stents decrease the risk of post ERCP pancreatic pancreatitis in high risk groups. In addition, the risk of severe pancreatitis was lower with pancreatic stents.