Early Endoscopic Pancreatic Duct Stenting in Combination Treatment of Acute Pancreatitis of Various Etiologies: A Systematic Review and Meta-Analysis

Acute pancreatitis is a critical emergency in contemporary abdominal surgery. Moderate and severe pancreatitis demonstrate the greatest management difficulties, with mortality rates reaching 50%–80% when complications develop. A promising treatment method is early endoscopic pancreatic duct stenting. However, there is currently no consensus on the efficacy and safety of this method, particularly in acute non-biliary pancreatitis. AIM: To analyze and summarize published data from on the efficacy and safety of early endoscopic pancreatic duct stenting in the combination therapy of patients with moderate to severe acute pancreatitis. A systematic review of publications was conducted across the Russian Science Citation Index, Google Scholar, PubMed, ScienceDirect, Scopus, and Cochrane databases. The search had no lower time limit, and its endpoint (upper limit) was set for June 1, 2025. The identified publications enabled traditional and Bayesian meta-analyses comparing treatment outcomes for patients who underwent endoscopic stenting as part of combination therapy and those whose management did not include this intervention. The inclusion criteria were retrospective and prospective comparative studies, diagnosed acute pancreatitis, and intervention time of up to 72 hours from disease onset. The endpoints included the incidence of infected pancreatic necrosis, organ dysfunction, pancreatic pseudocysts, and mortality rate. Meta-analysis was performed using a random effects model. The heterogeneity of studies was assessed using Cochran’s Q test, I2, and τ2. The risk of publication bias was evaluated using funnel plots. If asymmetry was detected, correction was applied using the trim-and-fill method. A separate analysis of the acute biliary pancreatitis subgroup was conducted. The meta-analysis included 13 studies reporting the treatment outcomes for 1798 patients. Regardless of the etiology of acute pancreatitis, patients who underwent pancreatic duct stenting showed a lower incidence of organ dysfunction, pancreatic pseudocysts, and mortality. Moreover, in the acute biliary pancreatitis subgroup, a decreased risk of infected pancreatic necrosis and pancreatic pseudocysts was reported after pancreatic duct stenting. Thus, the meta-analysis revealed that early endoscopic stenting of the pancreatic duct is an effective option for combination therapy for patients with moderate to severe acute pancreatitis. However, the non-randomized design and high risk of systematic errors in the included studies indicate that the reported results are preliminary and require confirmation in multicenter randomized controlled studies.