Pancreatic duct stenting to prevent post-ERCP pancreatitis: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND

Prophylactic pancreatic duct (PD) stenting has been proposed to mitigate the risk of post-ERCP pancreatitis (PEP), particularly in high-risk populations. The aim of this study was to systematically review the evidence of the efficacy of prophylactic PD stenting in reducing the incidence of PEP in patients undergoing ERCP, including subgroup analyses of high-risk and average risk populations.

METHODS

A systematic review and meta-analysis were conducted according to PRISMA guidelines. Randomized controlled trials (RCTs) evaluating prophylactic PD stenting versus no stenting in adults undergoing ERCP were included. The primary outcome was incidence of PEP. Secondary outcomes included PEP incidence in high-risk subgroups, adverse events unrelated to PEP, mortality.

RESULTS

Eighteen RCTs comprising 4637 participants (2380 in the stent group and 2257 in the no-stent group) were included. Prophylactic PD stenting significantly reduced the risk of PEP compared to no stenting (pooled OR 0.35, 95% CI 0.23 to 0.54, p < 0.05), with moderate heterogeneity (I2 = 66.9%). In the subgroup analysis, stenting reduced PEP risk in high-risk and average-risk populations (pooled OR 0.37, 95% CI 0.20 to 0.66, p-value = 0.0009; I2 = 76.9% and pooled OR 0.34, 95% CI: 0.18 to 0.63; p = 0.0006; I2 = 46.8%). The pooled odds ratio of adverse events unrelated to PEP was low (odds ratio is 1 with a 95% confidence interval of 0.21 - 4.85.), and mortality rates did not differ between groups (OR of 0.43 and a 95% CI of 0.09 to 2.09).

CONCLUSION

Prophylactic PD stenting appears to significantly reduce the risk of PEP, in both high- and average-risk patients. However, considerable heterogeneity and methodological limitations across studies highlight the need for future trials to refine patient selection, stent characteristics and combination of prophylactic strategies.

PROSPERO: CRD420250652709.