Intervention Review

Endoscopic retrograde cholangiopancreaticography with or without stenting in patients with pancreaticobiliary malignancy, prior to surgery

  1. Khalid Mumtaz1,*,
  2. Saeed Hamid2,
  3. Wasim Jafri3

Editorial Group: Cochrane Hepato-Biliary Group

Published Online: 18 JUL 2007

Assessed as up-to-date: 22 MAY 2007

DOI: 10.1002/14651858.CD006001.pub2

How to Cite

Mumtaz K, Hamid S, Jafri W. Endoscopic retrograde cholangiopancreaticography with or without stenting in patients with pancreaticobiliary malignancy, prior to surgery. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD006001. DOI: 10.1002/14651858.CD006001.pub2.

Author Information

  1. 1

    Aga Khan University Hospital, Department of Medicine, Karachi, Pakistan

  2. 2

    Aga Khan University Hospital, Dept. of Medicine, Karachi, Sind, Pakistan

  3. 3

    The Aga Khan University Hospital, Medicine, Karachi, Sind, Pakistan

*Khalid Mumtaz, Department of Medicine, Aga Khan University Hospital, Stadium Road, P.O. Box 74800, Karachi, Pakistan.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 18 JUL 2007




  1. Top of page
  2. Abstract
  3. Plain language summary
  4. アブストラクト
  5. 摘要


Postoperative morbidity and mortality are high in patients undergoing pancreatico-duodenectomy for malignant pancreatico-biliary stricture. Different approaches have been tried to improve the outcomes, including pre-surgical biliary stenting with endoscopic retrograde cholangiopancreaticography (ERCP).


To assess the beneficial and harmful effects of biliary stenting via ERCP for pancreatico-biliary stricture confirmed or suspected to be malignant, prior to surgery.

Search methods

We identified trials through The Cochrane Hepato-Biliary Group Controlled Trials Register (October 2006), the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (Issue 2, 2006), MEDLINE (1950 to October 2006), EMBASE (1980 to October 2006), and Science Citation Index Expanded (1945 to October 2006). We also searched the references in the published papers and wrote to stent producers.

Selection criteria

Randomised trials comparing ERCP with biliary stenting versus ERCP without biliary stenting for pancreatico-biliary malignancy prior to surgery.

Data collection and analysis

Two authors independently selected trials for inclusion and extracted data. The primary pre-surgical, post-surgical, and final outcome measures were mortality. The secondary outcomes were complications such as cholangitis, pancreatitis, bleeding, pancreatic fistula, intra-abdominal abscess, improvement in bilirubin, and quality of life. Dichotomous outcomes were reported as odds ratio (OR) with 95% confidence interval (CI) based on fixed- and random-effect models.

Main results

We identified two randomised trials with 125 patients undergoing pancreatico-duodenectomy; 62 patients underwent ERCP with biliary stenting and 63 had ERCP without biliary stenting prior to surgery. Pre-surgical mortality was not significantly affected by stenting (OR 3.14, 95% CI 0.12 to 79.26), while there were significantly more complications in the stented group (OR 43.75, 95% CI 2.51 to 761.8). Stenting had no significant effect on the post-surgical mortality (OR 0.75, 95% CI 0.25 to 2.24). However, post-surgical complications were significantly less in the stented group (OR 0.45, 95% CI 0.22 to 0.91). Overall mortality (OR 0.81, 95% CI 0.17 to 3.89) and complications (OR 0.50, 95% CI 0.01 to 23.68) were not significantly different in the two groups.

Authors' conclusions

We could not find convincing evidence to support or refute endoscopic biliary stenting on the mortality in patients with pancreatico-biliary malignancy. Large randomised trials are needed to settle the question of pre-surgical biliary stenting.


Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. アブストラクト
  5. 摘要

No evidence to support or refute endoscopic retrograde cholangiopancreaticography (ERCP) with stenting in patients with malignant pancreaticobiliary diseases, awaiting surgery

Pancreatico-biliary malignancy includes cancers of pancreas, ampulla, duodenum, and cholangiocarcinoma. There is significant morbidity and mortality related to surgery in these patients. Studies have claimed the beneficial role of biliary decompression, which can be performed via endoscopic retrograde cholangiopancreaticography (ERCP) with stent insertion pre-surgically. The review found that pre-surgical biliary stenting via ERCP did not improve the morbidity and mortality in patients with pancreatico-biliary malignancy. Further evidence about its efficiency is needed.



  1. Top of page
  2. Abstract
  3. Plain language summary
  4. アブストラクト
  5. 摘要







Cochrane Hepato-Biliary Group Controlled Trials Register(2006年10月)、コクラン・ライブラリ(2006年第2号)のCochrane Central Register of Controlled Trials(CENTRAL)、MEDLINE(1950年~2006年10月)、EMBASE(1980年~2006年10月)およびScience Citation Index Expanded(1945年~2006年10月)から試験を同定した。また、発表された論文中の参照文献を検索し、ステント製造業者に手紙を書いた。






膵頭十二指腸切除術を施行した患者125例を対象とした2件のランダム化試験を同定した。術前に、患者62例はERCPと胆管内ステント留置との併用、患者63例は胆管内ステント留置を伴わないERCPが施行されていた。術前死亡率のステント留置よる影響は有意ではなかったが(OR 3.14、95% CI 0.12~79.26)、ステント留置群の方が合併症は有意に多かった(OR 43.75、95% CI 2.51~761.8)。ステント留置は、術後死亡率に対する有意な効果はなかった(OR 0.75、95% CI 0.25~2.24)。しかし、術後合併症はステント留置群の方が有意に少なかった(OR 0.45、95% CI 0.22~0.91)。全死亡率(OR 0.81、95% CI 0.17~3.89)および全合併症(OR 0.50、95% CI 0.01~23.68)は、2群間で有意差はなかった。




監  訳: 吉田 雅博,2007.10.5

実施組織: 厚生労働省委託事業によりMindsが実施した。

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  1. Top of page
  2. Abstract
  3. Plain language summary
  4. アブストラクト
  5. 摘要



因惡性胰膽狹窄而接受胰十二指腸切除術的病人具有較高的併發症和死亡率。 人們嘗試各種方法來改善療效,包括術前利用內視鏡逆行性胰膽攝影術置放支架。




透過The Cochrane HepatoBiliary Group Controlled Trials Register (2006年10月), the Cochrane Central Register of Controlled Trials (CENTRAL) (2006年第2期), MEDLINE (1950年 2006年10月), EMBASE (1980年−2006年10月), Science Citation Index Expanded (1945 年−2006年10月), 我們也搜尋已發表文章的參考資料,並聯繫支架廠商。




2位作者單獨選擇試驗,收錄和提取資料。 主要結果是術前、術後和最終結果的死亡率。次要結果是包括膽管炎、胰臟炎、出血、胰臟?管、腹腔膿瘍等併發症,還有黃疸消退及生活品質。根據固定和隨機效果模式,二分法療效記錄成相對危險比 (OR) ,95% 信賴區間 (CI) 。


我們找出了2個隨機試驗,共包含125位病人,接受胰十二指腸切除術 62位病人接受內視鏡逆行性胰膽攝影術及支架置放, 63 位病人僅接受內視鏡逆行性胰膽攝影術而無置放支架。 術前死亡率沒有明顯受到支架的影響 (OR 3.14, 95% CI 0.12 – 79.26), 但是支架組出現了較多的併發症 (OR 43.75, 95% CI 2.51 761.8)。支架對於術後死亡率沒有顯著影響 (OR 0.75, 95% CI 0.25 2.24)。但是,支架組的術後併發症明顯較低 (OR 0.45, 95% CI 0.22 0.91)。 兩組的總體死亡率 (OR 0.81, 95% CI 0.17 3.89) 和併發症(OR 0.50, 95% CI 0.01 23.68)沒有顯著差異。




此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。