Background and study aims: 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). This systematic
review and network meta-analysis (NMA) aimed to examine whether a particular feature
of pancreatic stents is associated with lower incidence of PEP.
Patients and methods: 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 September 1993 to June 2013. 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.
Results: Among the 1377 citations identified from the database searches, 6 RCTs involving
561 patients were included. Three RCTs evaluated 5-Fr straight, flanged pancreatic
stents, two RCTs evaluated 5-Fr single-pigtail, unflanged stents, and three RCTs evaluated
3-Fr single-pigtail, unflanged stents. The probability of being ranked the best was
50.3 % (SD = 0.5, Markov chain error = 0.003) for 5-Fr single-pigtail, unflanged pancreatic
stents, 46.5 % for 5-Fr straight, flanged stents, and 3.1 % for 3-Fr single-pigtail,
unflanged stents.
Conclusion: 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.
