Prophylactic Pancreatic Stent Placement to Prevent Post-ERCP Pancreatitis: A Systematic Review and Meta-Analysis

Introduction: Post-ERCP pancreatitis (PEP) is considered a common complication that can sometimes be fatal. Studies showed that the incidence of PEP averages around 9.7% with a 0.7% mortality rate. Many strategies were presumed to prevent PEP including periprocedural aggressive hydration with Intravenous fluids, the periprocedural administration of non-steroidal anti-inflammatory medications (NSAIDS), or pancreatic duct stent placement. We conducted a meta-analysis to study the effectiveness of the prophylactic placement of a stent in the pancreatic duct in the prevention of PEP. Methods: We performed a comprehensive search of the databases: PubMed/MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials from inception through May 15th, 2023. We considered randomized controlled trials. We excluded abstracts, animal studies, case reports, case series, reviews, editorials, and letters to editors. The primary outcome was the occurrence of PEP. Also, we did a subgroup analysis based on the severity of PEP. The random-effects model was used to calculate the risk ratios (RR) and 95% confidence intervals (CI). A P value < 0.05 was considered statistically significant. Heterogeneity was assessed using the Higgins I2 index. Results: Fifteen randomized controlled trials involving 1,850 patients were included in the meta-analysis. All studies compared the occurrence of PEP which was significantly lower in the pancreatic stent placement group (5.9% vs 16.8%, RR 0.40, 95% CI 0.30-0.54, P< 0.001, I2 = 0%) (Figure 1a). Subgroup analysis based on the severity of PEP showed that prophylactic pancreatic stent placement was associated with lower occurrence of mild-moderate PEP (5.6% vs 13.9%, RR 0.46, 95% CI 0.34-.064, P < 0.001, I2 = 0%) (Figure 1b). Also, prophylactic pancreatic stent placement significantly lowered the occurrence of severe PEP (0% vs 1.6%, RR 0.26, 95% CI 0.09-0.76, P = 0.01, I2 =0%) (Figure 1c). Conclusion: Our meta-analysis demonstrated that the prophylactic placement of a stent in the pancreatic duct decreases the occurrence of PEP. It was especially helpful in significantly lowering the occurrence of severe PEP.Figure 1.: The occurrence of PEP pancreatitis with pancreatic stent placement.