Joaquim Coelho da Cruz Portela, Wanderley Marques Bernardo, Diogo Turiani Hourneaux de Moura, Tomazo Antônio Prince Franzini, Lara Meireles de Azeredo Coutinho, Vitor Ottoboni Brunaldi, Hugo Gonçalo Guedes, Eduardo Turiani Hourneaux de Moura, Marcos Eduardo Lera dos Santos, Gustavo Oliveira Luz, Eduardo Guimarães Hourneaux de Moura
Background and Aims Acute pancreatitis is one common and severe complication after endoscopic retrograde cholangiopancreatography. Randomized controlled trials have reported that pancreatic stenting may efficiently prevent post-ERCP pancreatitis. Methods Systematic review was conducted on MEDLINE/PubMed and other databases randomized controlled trials comparing patients undergoing endoscopic retrograde cholangiopancreatography with pancreatic stent versus endoscopic retrograde cholangiopancreatography without stent. Two independent reviewers assessed the eligibility. Primary outcome is to assess the degree of severity of pancreatitis (mild, moderate, and severe) and secondary hyperamylasemia, cholangitis, abdominal pain, duration of endoscopic retrograde cholangiopancreatography and length of hospital stay. Results Twelve randomized controlled trials selected a total of 3.310 patients. Meta-analysis showed that pancreatic stenting reduced pancreatitis risk to PEP (mild PEP: RD 0.06, 95% CI-0.09 - 0.03; moderate PEP: RD 0.03, 95 % CI-0.06 -0.01; severe PEP: (RD 0.02, 95% CI-0.05-0.01); Hyperaylasemia (RD-0.62, 95% CI-0.65-0.59) showed statistically significant difference. Cholangitis (RD 0.03, 95% CI-0.03-0.09), abdominal pain (RD 0.10, 95% CI-0.21-0.01), length of hospital stay after ERCP (RD 1.55, 95% CI-4.39 -1.29), total duration of the procedure (RD 2.97, 95% CI-0.19-6.12), showed no statistical significance. Conclusions Pancreatic stent placement is effective in reducing post-endoscopic retrograde cholangiopancreatography acute pancreatitis incidence in high-risk patients.
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