Pancreatic Duct Stenting for Preventing Post-ERCP Pancreatitis: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

PAN Tao , WANG Yiping , YANG Jinlin , TIAN Ling , LI Yaodong

Department of Gastroenterology; West China Hospital of Sichuan University; Chengdu 610041; China;

Corresponding author：

Keywords：

Post-endoscopic restrograde cholangiopancreatography pancreatitis; Pancreatic duct stenting; Randomized controlled trial; Systematic review

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Objective 　To evaluate the effectiveness and safety of pancreatic duct stenting in prevention of post-ERCP (endoscopic retrograde cholangiopancreatography) pancreatitis for patients at high risk.
Methods 　We searched the Controlled Trials Database of the Cochrane Upper Gastro-Intestinal and Pancreatic Disease Group (Issue 1, 2004), Cochrane Controlled Trials Register (Issue 1, 2004), MEDLINE (1966-2004, 4), EMBASE (1985-2004, 4), CBMdisk (1970-2004, 4), and the Chinese Cochrane Center Database of Clinical Trials; we handsearched 8 Chinese journals, and references of eligible studies were also screened for inclusion. Randomized controlled trials on pancreatic stent for preventing post-endoscopic restrograde cholangiopancreatography pancreatitis (PEP) were identified.The systematic review was conducted using methods recommended by the Cochrane Collaboration.
Results 　Six trials involving 468 high-risk patients for post-ERCP pancreatitis were included. The incidence of post-ERCP pancreatitis was significantly reduced by pancreatic duct stenting (Peto RR 0.31, 95% CI 0.19 to 0.52; P＜0.000 01; NNT=6). The incidence of severe PEP was also significantly lower in pancreatic duct stenting group compared with the control group (Peto OR 0.13, 95% CI 0.04 to 0.47; P=0.002; NNT=24). The results were consistent with the sensitivity-analysis when abstracts were excluded.
Conclusion 　Pancreatic duct stenting appears to be an effective method to prevent PEP. Due to the limitation of the included trials and their methodology, the results should be considered with caution. High quality and large-scale trials are required.

Citation： PAN Tao,WANG Yiping,YANG Jinlin,TIAN Ling,LI Yaodong. Pancreatic Duct Stenting for Preventing Post-ERCP Pancreatitis: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2004, 04(10): 693-699. doi: Copy

1.	［1］Cotton PB, Lehman G, Vennes JA, Geenen JE, Russell RCG, Meyers WC, Liguory C, Nickl N. Endoscopic sphincterotomy complications and their management: an attempt at consensus [J]. Gastrointest Endosc, 1991; 37 (3):383 - 393.
2.	［2］Freeman ML, Disario JA, Nelson DB, Fennerty MB, Lee JG, Bjorkman DJ, Overby CS, Aas J, Ryan ME, Bochna GS, Shaw MJ, Snady HW, Erickson RV, Moore JP, Roel JP. Risk factors for post-ERCP pancreatitis: a prospective,multicenter study [J]. Gastrointest Endosc, 2001; 54 (4):425 - 434.
3.	［3］Masci E, Toti G, Mariani A, Curioni S, Lomazzi A, Dinelli M, Minoli G, Crosta C, Comin U, Fertitta A, Prada A,Passoni GR, Testoni PA. Complications of diagnostic and therapeutic ERCP: a prospective multicenter study [J]. Am J Gastroenterol, 2001; 96(2): 417-423.
4.	［4］Loperfido S, Angelini G, Benedetti G, Chilovi F, Costan F,De Berardinis F, De Bernardin M, Ederle A, Fina P, Fratton A. Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study [J]. Gastrointest En dosc,1998; 48(1):1 -10.
5.	［5］Smithline A, Silverman W, Rogers D, Nisi R, Wiersma M,Jamidar P, Hawes R, Lehman G. Effect of prophylactic main pancreatic duct stenting on the incidence of biliary endoscopicsphincterotomy-induced pancreatitis in high-risk patients [J].Gastrointest Endosc, 1993;39(5): 652 - 657.
6.	［6］Sherman S, Earle FD, Bucksot L, Esber E, Pezzi J,Gottlieb K, Lehman G. Does leaving a main pancreatic duct stent in place reduced the incidence of precut biliary sphincterotomy(ES)-induced pancreatitis [J] ? Am J Gastroenterol, 1995;90(9):1 614.
7.	［7］Meyerson SM, Geenen JE, Johnson GK, Catalano MF,Geenen DJ, Schmalz MJ Hogan WJ. Pancreatic duct stenting decreases the incidence of post-ERCP pancreatitis: a prospective randomized study [J]. Gastroenterology, 1998; 114(4):G1 967.
8.	［8］Tarnasky PR, Palesch YY, Cunningham JT, Mauldin PD,Cotton PB, Hawes RH. Pancreatic stenting prevents pancreatitis after biliary sphincterotomy in patients with sphincter of Oddi dysfunction [J]. Gastroenterology, 1998;115(12):1518-1524.
9.	［9］Patel R, Tarnasky PR, Hennessy WS, Hawes RH, Payne KM, Nelles SE, Cunningham JT, Cotton PB. Does stenting after pancreatic sphincterotomy reduced post-ERCP pancreatitis in patients with prior biliary sphincterotomy: preliminary results of a prospective randomized trial [J]. Gastrointest Endosc, 1999; 49(4):80.
10.	［10］Fazel A, Quadri A, Catalano MF, Meyerson SM, Geenen JE. Does a pancreatic duct stent prevent post-ERCP pancreatitis? A prospective randomized study [J]. Gastrointest Endosc,2003; 57(3): 291 -294.
11.	［11］Sherman S, Lehman GA. ERCP and endoscopic sphincterotomy-induced pancreatitis [J].Pancreas,1991;6(2): 350-367.
12.	［12］Schulz KF, Chalmers I, Hayes RJ, Altman DG. Empirical evidence of bias: dimensions of methodological quality associated with estimates of treatment effects in controlled trials [J].JAMA, 1995; 273(5): 408-412.

1. ［1］Cotton PB, Lehman G, Vennes JA, Geenen JE, Russell RCG, Meyers WC, Liguory C, Nickl N. Endoscopic sphincterotomy complications and their management: an attempt at consensus [J]. Gastrointest Endosc, 1991; 37 (3):383 - 393.
2. ［2］Freeman ML, Disario JA, Nelson DB, Fennerty MB, Lee JG, Bjorkman DJ, Overby CS, Aas J, Ryan ME, Bochna GS, Shaw MJ, Snady HW, Erickson RV, Moore JP, Roel JP. Risk factors for post-ERCP pancreatitis: a prospective,multicenter study [J]. Gastrointest Endosc, 2001; 54 (4):425 - 434.
3. ［3］Masci E, Toti G, Mariani A, Curioni S, Lomazzi A, Dinelli M, Minoli G, Crosta C, Comin U, Fertitta A, Prada A,Passoni GR, Testoni PA. Complications of diagnostic and therapeutic ERCP: a prospective multicenter study [J]. Am J Gastroenterol, 2001; 96(2): 417-423.
4. ［4］Loperfido S, Angelini G, Benedetti G, Chilovi F, Costan F,De Berardinis F, De Bernardin M, Ederle A, Fina P, Fratton A. Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study [J]. Gastrointest En dosc,1998; 48(1):1 -10.
5. ［5］Smithline A, Silverman W, Rogers D, Nisi R, Wiersma M,Jamidar P, Hawes R, Lehman G. Effect of prophylactic main pancreatic duct stenting on the incidence of biliary endoscopicsphincterotomy-induced pancreatitis in high-risk patients [J].Gastrointest Endosc, 1993;39(5): 652 - 657.
6. ［6］Sherman S, Earle FD, Bucksot L, Esber E, Pezzi J,Gottlieb K, Lehman G. Does leaving a main pancreatic duct stent in place reduced the incidence of precut biliary sphincterotomy(ES)-induced pancreatitis [J] ? Am J Gastroenterol, 1995;90(9):1 614.
7. ［7］Meyerson SM, Geenen JE, Johnson GK, Catalano MF,Geenen DJ, Schmalz MJ Hogan WJ. Pancreatic duct stenting decreases the incidence of post-ERCP pancreatitis: a prospective randomized study [J]. Gastroenterology, 1998; 114(4):G1 967.
8. ［8］Tarnasky PR, Palesch YY, Cunningham JT, Mauldin PD,Cotton PB, Hawes RH. Pancreatic stenting prevents pancreatitis after biliary sphincterotomy in patients with sphincter of Oddi dysfunction [J]. Gastroenterology, 1998;115(12):1518-1524.
9. ［9］Patel R, Tarnasky PR, Hennessy WS, Hawes RH, Payne KM, Nelles SE, Cunningham JT, Cotton PB. Does stenting after pancreatic sphincterotomy reduced post-ERCP pancreatitis in patients with prior biliary sphincterotomy: preliminary results of a prospective randomized trial [J]. Gastrointest Endosc, 1999; 49(4):80.
10. ［10］Fazel A, Quadri A, Catalano MF, Meyerson SM, Geenen JE. Does a pancreatic duct stent prevent post-ERCP pancreatitis? A prospective randomized study [J]. Gastrointest Endosc,2003; 57(3): 291 -294.
11. ［11］Sherman S, Lehman GA. ERCP and endoscopic sphincterotomy-induced pancreatitis [J].Pancreas,1991;6(2): 350-367.
12. ［12］Schulz KF, Chalmers I, Hayes RJ, Altman DG. Empirical evidence of bias: dimensions of methodological quality associated with estimates of treatment effects in controlled trials [J].JAMA, 1995; 273(5): 408-412.

Chinese Journal of Evidence-Based Medicine

Pancreatic Duct Stenting for Preventing Post-ERCP Pancreatitis: A Systematic Review

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