Background and aim Stenosis of the pancreaticojejunostomy is a well-known long-term complication of pancreatoduodenectomy. Traditionally, the endoscopic approach consisted of endoscopic retrograde pancreaticography (ERP). Endoscopic ultrasound (EUS)-guided intervention has emerged as an alternative, but the success rate and adverse event rate of both treatment modalities are poorly known. We aimed to compare the outcome data of both interventions Methods We performed a systematic literature search using the Pubmed/Medline and Embase databases with the aim of summarizing the available data regarding efficacy and complications of ERP-and EUS-guided pancreatic duct (PD) drainage and compare these outcome data using uniform outcome measures in a multilevel logistic model. Results In total 13 studies were included, with 89 patients having undergone ERP-guided drainage and 113 patients EUS-guided drainage. An EUS-guided approach was significantly superior to an ERP-guided approach with regard to cannulation success (80% vs 20%, p<0.000), pancreatic duct opacification (86% vs 25%, p<0.000) and stent placement (73% vs 20%, p<0.000). An EUS-guided approach also appeared superior with regard to clinical outcomes such a pain resolution. The adverse event rate between the two treatment modalities could not be compared due to insufficient data. All included studies were found to be of low quality. Conclusion Based on limited available data, EUS-guided PD intervention appears superior to ERP-guided PD intervention.

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Despite a higher rate of nodal positivity among patients with T1a disease compared to previous reports, there was no impact on survival and current treatment guidelines appear appropriate for the management of T1a disease.