Pancreatic Duct Stenting During ERCP in Patients with Acute Biliary Pancreatitis: A Systematic Review and Meta-analysis.
Ahmed Elmoursi, Khaled Elfert, Azizullah Beran et al.
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In 30 seconds
This systematic review and random-effects meta-analysis assessed prophylactic pancreatic duct stenting during ERCP in adults with acute biliary pancreatitis. Five studies comprising 727 patients compared stenting with no stent. Stenting was associated with fewer post-ERCP complications (RR 0.45; 95% CI 0.22-0.89; p = 0.02), fewer pancreatic fluid collections, and shorter hospital stays. Differences in systemic inflammatory response syndrome, new-onset organ failure, and mortality were not statistically significant. The authors support selective stenting in high-risk patients when pancreatic duct cannulation is inadvertent, while noting the need for larger prospective trials.
Key findings
- Post-ERCP complications were lower with stenting (RR 0.45; 95% CI 0.22-0.89; p = 0.02).
- Pancreatic fluid collections were less frequent with stenting (RR 0.29; 95% CI 0.12-0.74; p = 0.009).
- Hospital length of stay was lower in the stent group (SMD - 1.10; 95% CI - 2.15 to - 0.06; p = 0.04).
- Differences in new-onset organ failure and mortality were not statistically significant.
Why it matters
ERCP in acute biliary pancreatitis may be indicated when biliary obstruction or cholangitis is suspected, and the procedure can be followed by complications. These pooled findings suggest pancreatic duct stenting may reduce some complications and hospital stay in this population. The lack of statistically significant differences in organ failure and mortality means the results do not establish benefit for these more serious outcomes.
What to keep in mind
The evidence came from five studies, with risk of bias varying across studies. The authors call for large-scale, multicenter prospective trials to validate patient selection and assess long-term outcomes.