Endoscopy 2018; 50(04): S40
DOI: 10.1055/s-0038-1637144
ESGE Days 2018 oral presentations
20.04.2018 – EUS: pancreas therapeutic
Georg Thieme Verlag KG Stuttgart · New York

ENDOSCOPIC INTERVENTION FOR PANCREATIC FLUID COLLECTIONS HAS BETTER OUTCOMES THAN PERCUTANEOUS OR SURGICAL DRAINAGE – A META-ANALYSIS

L Szakó
1   University of Pécs, Institute for Translational Medicine, Pécs, Hungary
,
P Mátrai
2   University of Pécs, Institute of Bioanalysis, Pécs, Hungary
,
P Hegyi
1   University of Pécs, Institute for Translational Medicine, Pécs, Hungary
,
K Márta
1   University of Pécs, Institute for Translational Medicine, Pécs, Hungary
,
Z Szakács
1   University of Pécs, Institute for Translational Medicine, Pécs, Hungary
,
Á Vincze
3   University of Pécs, First Department of Medicine, Pécs, Hungary
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

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    Aims:

    Inflammatory pancreatic fluid collections are common complications of both acute and chronic pancreatitis. They can be drained endoscopically (ED), percutaneously (PD) or surgically (SD) with diverse efficacy. Several retrospective and case control studies but only a limited number of randomized trials compared the outcomes of these treatment modalities.

    Methods:

    A meta-analysis was performed using the preferred reporting items for systematic review and meta-analysis protocol. A comprehensive literature search was conducted until November 2017 to identify studies comparing at least two of the treatment options regarding mortality, clinical success, recurrence, complications and length of hospitalisation (LoH). Initially, 1248 and 2539 articles were identified in Embase and PubMed, respectively, but only 25 studies were suitable for the meta-analysis.

    Results:

    ED had lower rate of recurrence (OR = 0.13; 95% CI 0.04, 0.40; p < 0.001), higher rate of clinical success (OR = 4.09; 95% CI 1.41, 11.88; p = 0.010) and shorter postoperative LoH (weighted mean difference (WMD)=-6.86; 95% CI -8.77, -4.94; p < 0.001) than PD based on six studies (including 550 and 125 patients, respectively). The LoH (WMD =-3.73; 95% CI -4.78, -2.68; p < 0.001) was shorter after ED than after SD based on 15 studies (including 785 and 898 patients, respectively). The recurrence and complication rates were higher (OR = 10.30; 95% CI 2.78, 38.18; p < 0.001 and OR = 3.29 95% CI 1.39, 7.77; p = 0.007, respectively), while the clinical success rate was lower (OR = 0.12; 95% CI 0.07, 0.21, p < 0.001) in PD compared to SD based on 11 studies (including 7161 and 8404 patients, respectively).

    Conclusions:

    ED and SD are equally effective in the treatment of inflammatory pancreatic fluid collections, but ED is associated with shorter LoH. PD has lower success rate and higher recurrence rate compared to the other modalities.


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