The role of prophylactic transpapillary pancreatic stenting in distal pancreatectomy: a meta-analysis

Abstract

Pancreatic fistula (PF) is the most frequent complication after distal pancreatectomy (DP). Prophylactic transpapillary pancreatic stenting (PTPS) has been proposed recently for the prevention of PF after DP. In this meta-analysis, a comprehensive search was performed in the PubMed, Embase, and Cochrane Library databases. Studies analyzing the results of PTPS in DP were considered eligible for this meta-analysis. The analyzed outcome variables included PF rate, postoperative morbidity, non-PF-related complications, mortality, operation duration, and hospital stay. Four studies with 200 patients were included in this review. Only one was a randomized controlled trial (RCT). The results showed that PTPS was associated with less PF formation (odds ratio, 0.45; 95% confidence interval [CI], 0.22-0.94; P = 0.03) and shorter hospital stay (mean difference, - 6.31; 95% CI, - 6.99 to - 5.62; P < 0.00001). There was no significant difference in terms of the other variables. In conclusion, current evidence indicates that PTPS could reduce PF incidence and hospital stay after DP, without increasing other complications or operative time. However, the evidence is not solid, because the single RCT conflicted with the other three retrospective reports. Thus, considering the limitation, more well-designed RCTs on this topic are needed in the future.

Attempts to prevent postoperative pancreatic fistula after distal pancreatectomy

“…Thus, it was hypothesized that preoperative pancreatic stenting prevents POPF after DP. A meta-analysis, including one RCT and three case-control studies, concluded that pancreatic stents in DP were associated with less POPF formation [77]. Abe et al [78] performed preoperative endoscopic pancreatic stenting for 10 patients who underwent DP, and no patients developed POPF.…”

Endoscopic Transpapillary Pancreatic Duct Stent Placement for Symptomatic Peripancreatic Fluid Collection Caused by Clinically Relevant Postoperative Pancreatic Fistula After Distal Pancreatectomy

“…Several studies have shown successful prophylaxis of POPF after DP by preoperative pancreatic duct stenting, which indicates that improved drainage through the papilla of Vater seems to prevent pressure-induced leakage from the pancreatic stump. 2,[12][13][14][15] This may play a pivotal role in POPF formation after DP. Although prophylactic preoperative pancreatic duct stenting is theoretically useful for preventing POPF after DP, this procedure is not recommended at present because of a lack of evidence from well-designed trials and the risk of endoscopic retrograde cholangiopancreatography (ERCP)-related complications, such as pancreatitis, cholangitis, or bleeding.…”

Reduction in post‐operative pancreatic fistula with polyethylene glycol and recombinant human albumin sealant following stapled distal pancreatectomy

“…Numerous techniques have been described to reduce the development of clinically relative POPF such as the use prophylactic pancreatic duct stenting, administration somatostatin analogues, performing a pancreatic-enteric anastomosis and the use of various electrosurgical transection methods. [20][21][22] The use of prophylactic pancreatic stenting may reduce leak rates in certain circumstances, but routine use has its own risks and cannot be advocated in all cases 23 It may be particularly be useful if there is the presence of a proximal benign proximal pancreatic duct stricture or in the setting of papillary stenosis We did not administer any somatostatin analogues in our series, although it may have a role in some circumstances. Most of the data on somatostatin analogues is however in the setting of pancreaticoduodenectomy and its potential benefits are offset against product costs.…”