A Meta-analysis Of The Incidence Of Post-ERCP Pancreatitis After Treatment Of Benign Biliary Stricture With Covered Self-expandable Metallic Stents And Multiple Plastic Stents

Objective:Biliary stent implantation via endoscopic retrograde cholangiopancreatography(ERCP)is the preferred option for the treatment of benign biliary stricture(BBS).Studies have shown that biliary stent implantation is associated with the incidence of post-ERCP pancreatitis(PEP).There is a certain degree of controversy over the difference in the incidence of PEP after the treatment of BBS by the implantation of multiple plastic stents(MPS)or covered self-expandable metal stents(CSEMS).To further explore the relationship between the two different stent types and the incidence of PEP,and to prevent PEP.In this study,a meta-analysis was used to include relevant studies in order to further clarify this issue.Methods:The relevant literature published from the establishment of the database to July 2022 was retrieved in eight Chinese and English databases by the predefined retrieval method.All literatures comparing CSEMS and MPS in the treatment of BBS were included.Quality evaluation and study data extraction were conducted respectively.In the analysis of data results,the relative risk ratio(RR)or mean deviation(MD)and corresponding 95%confidence interval(CI)were used to calculate the effect indicators,and the corresponding software was used for meta-analysis.The primary outcome was the incidence of PEP,while the secondary outcome included stricture resolution,stricture recurrence,overall adverse events,and ERCP sessions.Results:Twelve studies were included,with a total of 1498 patients(455 in the CSEMS group;1043 in the MPS group).The results showed that:(1)The incidence of PEP after treatment with CSEMS was statistically higher than that of MPS(RR=2.17,95%CI[1.47,3.21],P=0.0001).Subgroup analyses of randomized controlled trials(RCTs)and non-RCTs showed that the incidence of PEP was higher in the CSEMS group than in the MPS group in both RCTS and non-RCTs(P value 0.005 for both).A subgroup analysis of BBS secondary to orthotopic liver transplantation showed that the incidence of PEP was still higher in the CSEMS group than in MPS group(P=0.002).(2)There was no significant difference in the stricture resolution and stricture recurrence between the MPS group and the CSEMS group(RR=1.00,95%CI[0.94,1.06],P=0.98;RR=2.00,95%CI[1.01,3.93],P=0.05,respectively).(3)There was no significant difference in the incidence of overall adverse events between CSEMS and MPS groups(RR=1.08,95%CI[0.85,1.36],P=0.53).(4)Placement of CSEMS required significantly fewer ERCP sessions than that of MPS(RR=-1.40,95%CI[-2.50,-0.30],P=0.01).Conclusion:1.Compared with MPS,patients with BBS receiving CSEMS have a higher incidence of PEP.2.CSEMS and MPS have comparable stricture resolution,recurrence and overall adverse events.3.CSEMS requires fewer ERCP sessions than MPS to relief BBS.