预防性胰管支架置入与 ERCP 术后胰腺炎：系统评价和荟萃分析。
Prophylactic pancreatic stent placement and post-ERCP pancreatitis: a systematic review and meta-analysis.
机构信息
Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, 2-11-1 Hikarigaoka, Nerima-ku, Tokyo, Japan.
出版信息
Endoscopy. 2010 Oct;42(10):842-53. doi: 10.1055/s-0030-1255781. Epub 2010 Sep 30.
BACKGROUND AND STUDY AIMS
Pancreatitis is one of the most frequent complications of endoscopic retrograde cholangiopancreatography (ERCP). The placement of a prophylactic pancreatic stent after ERCP can help prevent post-ERCP pancreatitis (PEP). We aimed to provide an up-to-date meta-analysis regarding pancreatic stent placement for prevention of PEP and review the immediate adverse events associated with pancreatic stent placement.
METHODS
We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) considering pancreatic stent placement and the subsequent incidence of PEP. The primary outcome measure was the incidence of PEP. We also did a meta-analysis of RCTs and observational studies that reported on immediate adverse events, in order to estimate their incidence.
RESULTS
Eight studies, involving 680 patients, were included in the meta-analysis; 336 patients had pancreatic stent placement, and 344 patients formed the control group. Pancreatic stent placement was associated with a statistically significant reduction in PEP (relative risk [RR] 0.32, 95 % confidence interval [CI] 0.19 - 0.52; P<0.001). Subgroup analysis with stratification according to PEP severity showed that pancreatic stenting was beneficial in patients with mild to moderate PEP (RR 0.36, 95 %CI 0.22 -0.60; P<0.001) and in patients with severe PEP (RR 0.23, 95 %CI 0.06 - 0.91; P=0.04). Subgroup analysis according to patient selection demonstrated that pancreatic stenting was effective for both high risk and mixed-case groups. Weighted pooled estimates from between one and 17 studies for incidences of immediate adverse events were: overall complications 4.4 %; any infection 3.0 %; bleeding 2.5 %; cholangitis or cholecystitis 3.1 %; necrosis 0.4 %; pancreatic stent migration 4.9 % and occlusion 7.9 %; perforation 0.8 %; pseudocysts 3.0 %; and retroperitoneal perforation 1.2 %.
CONCLUSIONS
The meta-analysis shows that pancreatic stent placement after ERCP reduces the risk of PEP.
背景和研究目的
胰腺炎是内镜逆行胰胆管造影术（ERCP）最常见的并发症之一。ERCP 后放置预防性胰管支架有助于预防 ERCP 后胰腺炎（PEP）。我们旨在提供关于预防 PEP 的胰管支架放置的最新荟萃分析，并回顾与胰管支架放置相关的即时不良事件。
方法
我们对考虑胰管支架放置和随后 PEP 发生率的随机对照试验（RCT）进行了系统评价和荟萃分析。主要结局指标是 PEP 的发生率。我们还对报告即时不良事件的 RCT 和观察性研究进行了荟萃分析，以估计其发生率。
结果
共有 8 项研究，涉及 680 名患者，纳入荟萃分析；336 名患者接受了胰管支架放置，344 名患者为对照组。胰管支架放置与 PEP 发生率显著降低相关（相对风险 [RR] 0.32，95%置信区间 [CI] 0.19-0.52；P<0.001）。根据 PEP 严重程度进行亚组分析显示，胰管支架置入对轻度至中度 PEP 患者（RR 0.36，95%CI 0.22-0.60；P<0.001）和重度 PEP 患者（RR 0.23，95%CI 0.06-0.91；P=0.04）均有益。根据患者选择进行的亚组分析表明，胰管支架置入对高危和混合病例组均有效。1 至 17 项研究对即时不良事件发生率的加权汇总估计值为：总体并发症 4.4%；任何感染 3.0%；出血 2.5%；胆管炎或胆囊炎 3.1%；坏死 0.4%；胰管支架迁移 4.9%和闭塞 7.9%；穿孔 0.8%；假性囊肿 3.0%；和腹膜后穿孔 1.2%。
结论
荟萃分析表明，ERCP 后放置胰管支架可降低 PEP 的风险。
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