Comparison of postoperative complications between internal and external pancreatic duct stenting during pancreaticoduodenectomy: a meta-analysis

Background：Two types of pancreatic duct stents are used to improve postoperative outcomes of pancreatic anastomosis.The aim of this meta-analysis was to evaluate and compare the postoperative outcomes of patients with internal or external stenting during pancreaticoduodenectomy（PD）.Methods：We searched Pub Med,EMBASE,the Cochrane Library and Web of Science databases until the end of December,2014.Studies comparing outcomes of external vs.internal stent placement in PD were eligible for inclusion.Included literature was extracted and assessed by two independent reviewers.Results：Seven articles were identified for inclusion：three randomized controlled trials（RCTs）and four observational clinical studies（OCS）.The meta-analyses revealed that use of external stents had advantage on reducing the incidences of pancreatic fistula（PF）in total[odds ratio（OR）=0.69;95%confidence interval（CI）,0.48-0.99;P=0.04],PF in soft pancreas（OR=0.30;95%CI,0.16-0.56;P=0.0002）and delayed gastric emptying（DGE）（OR=0.58;95%CI,0.38-0.89;P=0.01）compared with internal stents.There were no significant differences in other postoperative outcomes between two stenting methods,including postoperative morbidity（OR=0.93;95%CI,0.39-2.23;P=0.88）,overall mortality（OR=0.70;95%CI,0.22-2.25;P=0.55）,and intra-abdominal collections（OR=0.67;95%CI,0.26-1.71;P=0.40）.Conclusions：Based upon this meta-analysis,the use of external pancreatic stents might have potential benefit in reducing the incidence of PF and DGE.Due to the limited number of original studies,more RCTs are needed to further support our result and clarify the issue.

Long-term follow-up of endoscopic papillectomy and the value of preventive pancreatic stent placement(with videos)

Background:Early-stage ampullary adenomas have only been reported in a small case series on endoscopic management.Hence,this study aimed to evaluate the long-term outcomes of early ampullary adenoma with endoscopic management and identify the risk factors for acute pancreatitis after endoscopic papillectomy(EP).Methods:In this study,115 patients who underwent EP at Changhai Hospital(Shanghai,China)between January 2012 and December 2018 were retrospectively analysed.Endoscopy was performed at 1,3,6,and 12months after EP.Data were statistically analysed using the t-test or the Mann–Whitney U test.Results:A total of 107 patients were included in this study and the follow-up period was 75643 months.The average age of the 107 patients was 54.6 years and the average tumor size was 17mm.The average age of the patients(53.7610.7 years vs 55.2610.5 years,P=0.482),minimum tumor size(13 vs 19mm,P=0.063),and complete resection rate(84.78%vs 85.25%,P=0.947)did not differ significantly between the stent placement and non-stent placement groups.Post-EP acute pancreatitis rates in the non-stent placement and stent placement groups were 11.48%and 4.35%,respectively.The risk of post-EP acute pancreatitis was significantly associated with the preoperative carcinoembryonic antigen level in univariate analysis,but not in multivariate analysis.The risk of post-EP acute pancreatitis was not significantly associated with the placement of the pancreatic stent in either univariate or multivariate analysis.Moreover,delayed proximal pancreatic duct stenosis was not noted in either group during long-term follow-up.Conclusions:EP is a satisfactory option for treating adenomas of the ampulla of the duodenum.