Prophylactic pancreatic stent placement and post-ERCP pancreatitis: an updated meta-analysis

Mazaki, Takero; Mado, Kazunari; Masuda, Hideki; Shiono, Motomi

doi:10.1007/s00535-013-0806-1

Cited by 196 publications

(143 citation statements)

References 41 publications

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“…This found that pancreatic stent placement was associated with significant reduction of post-ERCP pancreatitis (RR=0.39, 95%CI: 0.29-0.53, P < 0.001) as compared with no stent placement. Subgroup analysis demonstrated that pancreatic stent placement was effective for both high-risk and mixed case groups [34] . Another meta-analysis by Choudhary et al [35] analysed eight RCTs (656 patients) and this showed that prophylactic pancreatic stents decreased the odds of post-ERCP pancreatitis (OR = 0.22; 95%CI: 0.12-0.38, P < 0.01) with an absolute risk difference of 13%.…”

Section: Ercp Techniquementioning

confidence: 99%

Prevention of post-ERCP pancreatitis

Wong

Tsai

2014

WJGP

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Post-procedure pancreatitis is the most common complication of endoscopic retrograde cholangio pancreatography (ERCP) and carries a high morbidity and mortality occurring in at least 3%-5% of all procedures. We reviewed the available literature searching for "ERCP" and "pancreatitis" and "post-ERCP pancreatitis". in PubMed and Medline. This review looks at the diagnosis, risk factors, causes and methods of preventing post-procedure pancreatitis. These include the evidence for patient selection, endoscopic techniques and pharmacological prophylaxis of ERCP induced pancreatitis. Selecting the right patient for the procedure by a risk benefits assessment is the best way of avoiding unnecessary ERCPs. Risk is particularly high in young women with sphincter of Oddi dysfunction (SOD). Many of the trials reviewed have rather few numbers of subjects and hence difficult to appraise. Meta-analyses have helped screen for promising modalities of prophylaxis. At present, evidence is emerging that pancreatic stenting of patients with SOD and rectally administered nonsteroidal anti-inflammatory drugs in a large unselected trial reduce the risk of post-procedure pancreatitis. A recent meta-analysis have demonstrated that rectally administered indomethecin, just before or after ERCP is associated with significantly lower rate of pancreatitis compared with placebo [OR = 0.49 (0.34-0.71); P = 0.0002]. Number needed to treat was 20. It is likely that one of these prophylactic measures will begin to be increasingly practised in high risk groups.© 2014 Baishideng Publishing Group Co., Limited. All rights reserved. Key words: Acute pancreatitis; Endoscopic retrograde cholangio pancreatographyCore tip: Select patients carefully, and give high risk patients rectal indomethacin.Wong LL, Tsai HH. Prevention of post-ERCP pancreatitis.

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Section: Ercp Techniquementioning

confidence: 99%

Prevention of post-ERCP pancreatitis

Wong

Tsai

2014

WJGP

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“…In the latest meta-analysis including 14 studies, pancreatic duct stent placement was associated with a statistically significant reduction of PEP (RR 0.39; 95 % CI 0.29-0.53; p < 0.001). Subgroup analysis stratified according to the severity of PEP showed that a stent was beneficial in patients with mild to moderate PEP (RR 0.45; 95 % CI 0.32-0.62; p < 0.001) and in patients with severe PEP (RR 0.26; 95 %CI 0.09-0.76; p = 0.01) [23][24][25].…”

Section: Guidewire Cannulationmentioning

confidence: 95%

Overview of ERCP Complications: Prevention and Management

Guda

Freeman

2015

ERCP and EUS

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“…In a meta-analysis by Mazaki et al, PSP was shown to reduce rates of post-ERCP pancreatitis from 19% in the control group to 7% in the stent group. 3 In one account, failed PSP in patients saw PEP in 35% of cases, compared to 13-29% in those where PSP was not attempted. At present, there are eight randomized controlled studies and two meta-analyses addressing this topic.…”

Section: Literature Reviewmentioning

confidence: 99%