Pancreatic Duct Stenting During ERCP in Patients with Acute Biliary Pancreatitis: A Systematic Review and Meta-analysis.

BACKGROUND

In patients with acute biliary pancreatitis (ABP), endoscopic retrograde cholangiopancreatography (ERCP) is generally recommended in the setting of suspected biliary obstruction or concomitant cholangitis. Prophylactic pancreatic duct (PD) stenting has been shown to lower the risk of post-ERCP pancreatitis in high-risk patients, yet its effect on the course of ABP specifically is not well understood. In this context, the present study aims to determine whether PD stenting during ERCP can reduce the likelihood of worsening pancreatitis in patients with ABP who undergo ERCP.

OBJECTIVE

To evaluate the impact of prophylactic PD stenting on clinical outcomes in patients with ABP undergoing ERCP, focusing on post-ERCP complications and hospital-related outcomes including length of stay (LOS) and mortality.

METHODS

A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. PubMed, Embase, Cochrane Library, and CINAHL were searched for studies published between January 2010 and June 2025. Eligible studies compared outcomes between PS and no-stent groups in adult ABP patients undergoing ERCP. Data were synthesized using a random-effects model in Review Manager (RevMan) 5.4.1. Risk of bias was assessed using ROBINS-I.

RESULTS

Five studies comprising 727 patients were included. PS significantly reduced post-ERCP complications compared to controls (RR 0.45; 95% CI 0.22-0.89; p = 0.02). PS was associated with a significant reduction in pancreatic fluid collections (RR 0.29; 95% CI 0.12-0.74; p = 0.009). PS was also associated with reduced hospital LOS (SMD - 1.10; 95% CI - 2.15 to - 0.06; p = 0.04). The incidences of systemic inflammatory response syndrome (SIRS), new-onset organ failure (OF) (RR 0.57; 95% CI 0.22-1.48; p = 0.25; I2 = 0%), and mortality (RR 0.31; 95% CI 0.08-1.16; p = 0.08; I2 = 0%) were all lower in the stent group compared with controls, although these differences did not reach statistical significance. Risk of bias varied across studies, with most demonstrating a mild-to-moderate overall risk. Risk of bias was generally low across studies, with one study demonstrating moderate risk.

CONCLUSIONS

Prophylactic pancreatic duct stenting is associated with a significant reduction in post-ERCP complications, lower rates of pancreatic fluid collections, and shorter hospitalization in patients with acute biliary pancreatitis undergoing ERCP. These findings support selective use of PS during inadvertent PD cannulation in high-risk ABP populations. Future large-scale, multicenter prospective trials are required to optimize stent characteristics, validate patient selection criteria, and evaluate long-term outcomes.