P0026 - Prophylactic Pancreatic Duct Stenting to Reduce the Risk of Post Ampullectomy Pancreatitis: A Comprehensive Review and Meta-Analysis of 1858 Patients

Saurabh Chandan, MD¹, Andrew Canakis, DO², Smit Deliwala, MD³, Michael Frohlinger, MD², Dushyant Singh. Dahiya, MD⁴, Shahab R. Khan, MBBS⁵, Babu Mohan, MD, MS⁶, Daryl Ramai, MD⁷, Antonio Facciorusso, MD⁸, Neil R.. Sharma, MD⁹, Douglas G. Adler, MD¹⁰, Gursimran S. Kochhar, MD^11
1Creighton University School of Medicine, Omaha, NE; ²University of Maryland School of Medicine, Baltimore, MD; ³Emory University School of Medicine, Atlanta, GA; ⁴University of Kansas School of Medicine, Kansas City, KS; ⁵Brigham and Women's Hospital, Harvard Medical School, Boston, MA; ⁶University of Utah Health School of Medicine, Salt Lake City, UT; ⁷University of Utah School of Medicine, Salt Lake City, UT; ⁸University of Foggia, Foggia, Italy, Neptune, NJ; ⁹Parkview Cancer Institue, Fort Wayne, IN; ¹⁰Center for Advanced Therapeutic (CATE), Centura Health, Porter Adventist Hospital, Peak Gastroenterology, Denver, CO; ¹¹Allegheny Health Network, Pittsburgh, PA

Introduction: Endoscopic ampullectomy (EA) for ampullary lesions is an effective treatment modality compared to surgery. However, complications such as bleeding, papillary stenosis and pancreatitis can occur. The effectiveness of prophylactic pancreatic duct stenting (PPDS) in preventing post ampullectomy pancreatitis (PAP) has been reported, however results are conflicting. We conducted a systematic review and meta-analysis looking at the use of PPDS in reducing PAP as well as overall post ampullectomy complications.

Methods: Multiple databases were searched through May 2023. Meta-analysis was performed to determine pooled proportions and relative risk (RR) with 95% confidence intervals (CI) of PAP, with and without PPDS. Pooled rates of adverse events including perforation, delayed bleeding, cholangitis, and procedure related mortality were assessed. Random-effects model was used for our meta-analysis.

Results: Thirty-four studies with 1858 patients (1217 with PPDs, 623 without PPDs) were included in our final analysis. The overall pooled rate of PAP was 12.3% (CI 10.3-14.5, I² 41). We found no statistically significant difference in rates of PAP among patients with PPDS, 11.9% (CI 8.9-15.7, I² 56) and without PPDS, 16.6% (CI 13.5-20.2, I² 7), RR 0.8 (CI 0.51-1.28, I² 57), p=0.4 [Figure 1]. In terms of severe PAP, we found no difference between the two groups, RR 0.5 (CI 0.16-1.65, I² 0), p=0.3. Among all studies conducted in USA, Europe, those with >50 patients and published as full-length manuscripts, we found that while pooled rate of PAP was numerically in higher in patients without PPDS compared to those with PPDS, the difference between the two did not reach statistical significance, RR 0.5 (CI 0.24-1.07, I² 0), p=0.07; RR 0.7 (CI 0.31-1.4, I² 58), p=0.3, RR 0.95 (CI 0.56-1.62, I² 57), p=0.9 and RR 0.73 (CI 0.45-1.19, I² 54), p=0.2, respectively. Overall pooled rates of successful en-bloc, piecemeal resection, ampullary stenosis, post procedural bleeding, perforation, cholangitis and procedure related mortality were 74.8%, 25.1%, 3.6%, 11.1%, 4.2%, 3.5%, and 1.3%, respectively.

Discussion: Our analysis shows that PPDS at the time of EA offers a protective effect against PAP. While we were unable to find a statistically significant difference among the PPDS vs no PPDS group, this is likely due to variation among studies in terms of lesion size, length/size of pancreatic stent used and etiology of ampullary lesions. Future well-designed trials are needed to validate our findings.



Disclosures:


Saurabh Chandan, MD¹, Andrew Canakis, DO², Smit Deliwala, MD³, Michael Frohlinger, MD², Dushyant Singh. Dahiya, MD⁴, Shahab R. Khan, MBBS⁵, Babu Mohan, MD, MS⁶, Daryl Ramai, MD⁷, Antonio Facciorusso, MD⁸, Neil R.. Sharma, MD⁹, Douglas G. Adler, MD¹⁰, Gursimran S. Kochhar, MD¹¹. P0026 - Prophylactic Pancreatic Duct Stenting to Reduce the Risk of Post Ampullectomy Pancreatitis: A Comprehensive Review and Meta-Analysis of 1858 Patients, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.