Prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis using pancreatic stents: A review of efficacy, diameter and length

Table 1 Randomized controlled trials of prophylactic pancreatic stent insertion for preventing post-endoscopic retrograde cholangiopancreatography pancreatitis

Author	Yr	Country	Sample number		Risk factors	PEP n (%)	Criteria for PEP
			Stent	No stent		Stent/no stent
Smithline et al[21]	1993	United States	43	50	Acinarization, pre-cutting, history of pancreatitis	Total 6 (14)/9 (18), P = 0.299; Mild 5 (12)/5 (10), P = NA; Moderate 1 (2)/2 (4) P = NA; Severe 0 (0)/2 (4), P = 0.264	Cotton
Tarnasky et al[22]	1998	United States	41	39	SOD	Total 1 (2)/10 (26), P = 0.003; Mild 0 (0)/5 (13), P = NA; Moderate 0 (0)/5 (13), P = NA; Severe 0 (0)/0 (0), P = NA	Cotton
Fazel et al[23]	2003	United States	38	36	Difficult cannulation SOD	Total 2 (5.3)/10 (28), P < 0.05; Mild 2 (5.3)/5 (14), P = NA; Moderate 0 (0)/2(6), P = NA; Severe 0 (0)/3 (8), P = NA	Cotton
Sofuni et al[24]	2007	Japan	98	103	IDUS, biopsy, EPBD, SOD, POCS, Duodenal diverticulum, acinarization, initial pancreato-graphy, difficulty of cannulation	Total 3 (3)/14 (13.6), P = 0.019; Mild 2 (2)/8 (7.8), P = 0.139; Moderate 1 (1)/6 (4.6), P = 0.156; Severe 0 (0)/0(0), P = NA	Cotton
Tsuchiya et al[25]	2007	Japan	32	32	EST, IDUS, EPBD, SOD, pancreatic duct cannulation	Total 1 (3.1)/4 (12.5), P > 0.05; Mild 1 (3.1)/2 (6.3), P = NA; Moderate 0 (0)/1 (3.1), P = NA; Severe 0 (0)/1 (3.1), P = NA	Cotton
Ito et al[26]	2010	Japan	35	35	History of pancreatitis, history of PEP, pancreatic duct opacification, EST, IDUS, EPBD, cytology of pancreatic juice, biopsy of pancreatic duct	Total 1 (2.9)/8 (23) (per-protocol) 0 (0)/9 (24), P = 0.0096; Mild 1 (2.9)/8 (23); Moderate and severe 0	Cotton
Sofuni et al[28]	2011	Japan	213	213	History of pancreatitis, SOD, pancreato-graphy, EST, precut sphincter-otomy, EPBD, CBD tissue sampling, pancreatic duct tissue sampling, biliary drainage without EST, ENBD without EST, IDUS, difficulty of cannulation, long procedural time	(Intention to treat) Total 20 (9.4)/31 (14.6), P = 0.076; Mild 16 (7.5)/22 (10.3), P = 0.24; Moderate 4 (1.9)/8 (3.8), P = 389; Severe 0 (0)/1 (0.5), P = 1.00; (Full analysis set) Total 16 (7.9)/31 (15.2), P = 0.021; Moderate 12 (5.9)/22 (10.8), P = 0.77; Mild 4 (1.97)/8 (3.92), P = 0.952; Severe 0 (0)/1 (0.5), P = 1.00	Cotton
Pan et al[27]	2011	China	20	20	History of pancreatitis, pancreatic duct cannulation, pancreato-graphy, difficult cannulation, hyperamyla-semia	Total 4 (20)/14 (70), P < 0.01; Mild, moderate, severe NA	Cotton
Kawaguchi et al[29]	2012	Japan	60	60	History of PEP, SOD, difficult cannulation, pre-cutting, pancreatic duct biopsy, IDUS of pancreatic duct	Total 1 (1.7)/8 (13.3), P = 0.032; Mild 1 (1.7)/8 (13.3), P = 0.032	Modified Cotton
Lee et al[30]	2012	Korea	50	51	Difficult biliary cannulation, pancreatic cannulation	Total 6 (12)/15 (29.4), P = 0.031; Mild 5 (10)/12 (23.5), P = NA; Moderate 1 (2)/2 (3.9), P = NA; Severe 0 (0)/1 (2), P = NA	Cotton
Yin et al[31]	2016	China	104	102	History of PEP, cannulation difficulty, periampullary diverticulum	Total 8 (7.7)/18 (17.7), P = 0.031, Mild, Moderate, severe NA	NA

RCT: Randomized controlled trial; PEP: Post-endoscopic retrograde cholangiopancreatography pancreatitis; SOD: Sphincter of Oddi dysfunction; IDUS: Intraductal ultrasonography; EPBD: Endoscopic papillary balloon dilation; POCS: Peroral cholangioscopy; EST: Endoscopic sphincterotomy; CBD: Common bile duct; ENBD: Endoscopic nasobiliary drainage; NA: Not available.