P1698 - Meta-Analysis and Systematic Review of Pancreatic Stents in Preventing Post-ERCP Pancreatitis

Jonathan Sadik, MD¹, Selena Zhou, MD¹, Aneesa Chowdhury, MD¹, Rishi Das, MD, MPH¹, Andrew Foong, MD¹, Thu A. Mai, MD¹, Varun Angajala, MD¹, Helen Lee, ANPC¹, Ara Sahakian, MD¹, Robyn Rosasco, MS², Bashar Qumseya, MD, MPH³, James Buxbaum, MD^1
1University of Southern California, Los Angeles, CA; ²Florida State University, Tallahassee, FL; ³University of Florida, Gainesville, FL

Introduction: Pancreatitis is a common and potentially devastating complication of ERCP. Prior studies have shown that prophylactic pancreatic duct stent (PS) placement may be effective to reduce post-ERCP pancreatitis (PEP) in high-risk patients, such as patients with sphincter of Oddi dysfunction or prior history of pancreatitis. However, prior meta-analyses are missing relevant studies both contemporaneously and since published. We aim to perform a comprehensive analysis comparing PS placement to no PS placement to prevent PEP in high-risk patients.

Methods: In conjunction with a health sciences librarian, Ovid Medline, Embase and Embase Classic, Cochrane Library, and Web of Science were searched from inception to March 26, 2021. Randomized controlled trials that directly compared PS placement versus no PS placement in preventing PEP were included.

Our primary outcome was the incidence of PEP. Additional outcomes included incidence of mild PEP, moderate PEP, and severe PEP, as well as the incidence of adverse outcomes including hemorrhage, infection, and pancreatic duct perforation. Quantitative data was harmonized using random effects models.

Results: The search yielded 1,668 citations, 444 of which were removed as duplicates. Each study was assessed by two reviewers. 116 articles were selected for full text review, and eighteen randomized controlled trials were identified of pancreatic stent placement to prevent post-ERCP pancreatitis.

In sum, 1,295 patients were assigned to pancreatic stent prophylaxis and 1,299 to no stent placement. There was a significant reduction in odds of PEP in the PS group (Figure 1, OR 0.36 [95% CI 0.28-0.46]). In addition, PS placement was strongly protective against severe pancreatitis (Table 1, OR 0.25 [95% CI 0.07-0.81]). Stent placement was successful in 98% of cases (95% CI 95-100) and there was no difference in pancreatic duct perforation, bleeding, or infection (Table 1).

Discussion: Pancreatic stent placement is an effective intervention to reduce the incidence of PEP in high-risk patients. Further, pancreatic stent placement is particularly effective against the severe forms of PEP. There is no significant difference in major non-pancreatitis adverse events for pancreatic stent placement compared to no stent placed.




Disclosures:


Jonathan Sadik, MD¹, Selena Zhou, MD¹, Aneesa Chowdhury, MD¹, Rishi Das, MD, MPH¹, Andrew Foong, MD¹, Thu A. Mai, MD¹, Varun Angajala, MD¹, Helen Lee, ANPC¹, Ara Sahakian, MD¹, Robyn Rosasco, MS², Bashar Qumseya, MD, MPH³, James Buxbaum, MD¹. P1698 - Meta-Analysis and Systematic Review of Pancreatic Stents in Preventing Post-ERCP Pancreatitis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.