Endoscopic pancreatic duct stent placement for inflammatory pancreatic diseases. World J Gastroenterol. 2007;13:5971-5978. [PMID: 18023085 DOI: 10.3748/wjg.13.5971]

External pancreatic duct stent reduces pancreatic fistula: a meta-analysis and systematic review

BACKGROUND

Postoperative pancreatic fistula formation (POPF) remains one of the most common and detrimental complications following pancreaticojejunostomy (PJ). The aim of this meta-analysis is to analyze the efficacy of external pancreatic duct stent placement in preventing POPF formation following PJ.

METHODS

The primary end-point was the incidence of POPF formation following pancreaticoduodenectomy (PD) in the presence and absence of external stent placement. Secondary outcomes examined were the incidence of perioperative mortality, delayed gastric emptying, postoperative wound infection, operative time, blood loss, and length of hospital stay.

RESULTS

Four trials were included comprising 416 patients. External pancreatic duct stenting was found to reduce the incidence of both any grade POPF formation (OR 0.37, 95% CI = 0.23 to 0.58, p = 0.0001) and clinically significant (grade B or C) POPF formation (OR 0.50, 95% CI = 0.30 to 0.84, p = 0.0009) following PD. The use of an external stent was also found to significantly lessen length of hospital stay (SMD -0.39, 95% CI = -0.63 to -0.15, p = 0.001).

CONCLUSIONS

This analysis has shown that external pancreatic duct stenting is indeed efficacious in the incidence of both any grade as well as clinically significant POPF formation following PD. Length of hospital stay was also found to be significantly less by external duct stenting.

Endoscopic treatment for chronic pancreatitis: indications, technique, results

Endoscopic treatment associated with or without extracorporeal shock wave lithotripsy (ESWL) for chronic pancreatitis has been employed for about 20 years. Although two randomized control trials have revealed the greater effectiveness of surgery as compared to endoscopic treatment for chronic pancreatitis, a considerable number of patients have successfully obtained complete and long-term relief from pain by the less invasive endoscopic treatment. In this review, we discuss the indications, techniques and results of endoscopic treatment and ESWL for painful chronic pancreatitis. We also discuss the characteristic clinical features that are predictive of a good response to endoscopic treatment and ESWL.

Progress in evidence-based medicine for treatment of severe acute pancreatitis

Severe acute pancreatitis (SAP) is an abdominal catastrophe with a high morbidity and mortality. Up to now, no special drugs or therapeutic methods are available for SAP. Since evidence-based medicine came into being, much more clinical evidence has provided better choice of treatment for SAP. However, such evidence does not fit for all ASP patients based on its critical inclusion and exclusion criteria. It is, therefore, important to treat ASP patients by combining such evidence with clinical experiences.