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News

Pancreatic stents for the prevention of post-ERCP pancreatitis in high-risk patients

This month's issue of Endoscopy compares 5-Fr vs. 3-Fr pancreatic stents for the prevention of post-ERCP pancreatitis in high-risk patients.

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Placement of a pancreatic stent is recommended for the prevention of pancreatitis after endoscopic retrograde cholangiopancreatitis (ERCP) among high-risk patients.

However, it is not known whether there is a particular feature of the pancreatic stent that is associated with a lower incidence of post-ERCP pancreatitis (PEP).

Dr Vikesh Singh and colleagues performed a systematic review and network meta-analysis (NMA) to examine whether a particular feature of pancreatic stents is associated with lower incidence of PEP.

The MEDLINE, Embase, and Cochrane Library databases were searched for randomized controlled trials (RCTs) that evaluated the efficacy of pancreatic stents in the prevention of PEP from 1993 to 2013.

The probability of being ranked the best was 50% for 5-Fr single-pigtail, unflanged pancreatic stents
Endoscopy

Trials that reported the incidence of PEP in high-risk patients randomized to one vs. another type of pancreatic stent or vs. no stent at all were included in the analysis.

Among the 1377 citations identified from the database searches, 6 RCTs involving 561 patients were included.

The research team identified 3 RCTs that evaluated 5-Fr straight, flanged pancreatic stents.

The team found 2 RCTs that evaluated 5-Fr single-pigtail, unflanged stents, and 3 RCTs that evaluated 3-Fr single-pigtail, unflanged stents.

The probability of being ranked the best was 50% for 5-Fr single-pigtail, unflanged pancreatic stents, 46% for 5-Fr straight, flanged stents, and 3% for 3-Fr single-pigtail, unflanged stents.

Dr Singh and team conclude, "The 5-Fr pancreatic stent is superior to the 3-Fr pancreatic stent for the prevention of PEP in high-risk patients."

"The 5-Fr single-pigtail, unflanged pancreatic stent and 5-Fr straight, flanged pancreatic stent performed similarly and both performed better than the 3-Fr pancreatic stent in preventing PEP, suggesting that stent diameter is more important for the prevention of PEP than type of stent or the presence of flanges."

Endoscopy 2014; 46(07): 573-580
21 July 2014

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