Comparative outcomes of endoscopic ultrasound–guided cystogastrostomy for peripancreatic fluid collections: a systematic review and meta-analysis

Abstract

Background: Endoscopic ultrasound–guided cystogastrostomy has become the first-line treatment for symptomatic peripancreatic fluid collections. The aim of this study is to analyze the efficacy and safety of cystogastrostomy via a meta-analysis of the literature. Methods: We performed a systematic search of PubMed and Medline databases for studies published from January 2005 to May 2018. We included randomized controlled trials along with retrospective and prospective observational studies reporting endoscopic ultrasound–guided cystogastrostomy stent placement for peripancreatic fluid collections. The primary outcome for our meta-analysis was complete peripancreatic fluid collection resolution on imaging. Our secondary outcomes included comparative efficacy and safety of the procedure for pseudocysts and walled-off pancreatic necrosis using metal and plastic stents. Results: Seventeen articles involving 1708 patients met our inclusion criteria for meta-analysis. Based upon the random effects model, the pooled technical success rate of cystogastrostomy was 88% (95% confidence interval = 83–92 with I 2 = 85%). There was no difference in the technical success rate between pancreatic pseudocysts and walled-off pancreatic necrosis (91% and 86%, respectively p = nonsignificant). The adverse event rates for metal and plastic stents were equivalent (14% and 18%, respectively, p = nonsignificant). Conclusion: Endoscopic ultrasound–guided cystogastrostomy stents are effective in the treatment of pancreatic pseudocysts and walled-off pancreatic necrosis. We found no difference in technical success or adverse event rates of drainage based on peripancreatic fluid collection type or stent used.

Comparative Outcomes of EUS-Guided Lumen-Apposing Mental Stents Drainage for Pancreatic Pseudocysts and Walled-off Necrosis: Case Series and Meta-Analysis

“…On the other hand, the different techniques of LAMS deployment, treatment protocols and endoscopists with varying level of experiences might also be the reasons for the inconsistency with consideration of the heterogeneity of the previous studies. Another previously published meta-analysis conducted by Renelus et.al 12 included not merely mental stents, but also plastic stents, which has a confounding impact on the outcome of PFCs. The study from Varadarajulu et al 30 in favor of our ndings also showed clinical success was signi cantly higher for PPC and pancreatic abscess compared to WON.…”

“…However, a meta-analysis from Hammad et al published in 2018, aiming to compare the e cacy of LAMS drainage for PFCs with plastic stents, reported endoscopic LAMS drainage for WON has no difference with that of PPC 11 , meanwhile another meta-analysis from Renelus et al 12 included metal and plastic stents published in 2019 also supported this nding. With regard to the controversial results of stents in the management of PFCs, we have carried out a comparative study centering on the e cacy of LAMS for PPC and WON through a meta-analysis combined with a series of medical records from our medical center to evaluate the outcomes of different types of PFCs.…”

Management of pancreatic fluid collections

“…Overall, a recent systemic review and meta-analysis of outcomes related to endoscopic ultrasound-guided cystogastrostomy for pancreatic fluid collections by Renelus et al included seventeen studies involving 1,708 patients and reported the pooled adverse events rates for metal stents to be 14% and plastic stents to be 18% (76). Overall complications are rare and most can be managed successfully when recognized.…”

Advancements in the endoscopic treatment of pancreatic fluid collections

“… 50 However, some researches suggest no significant difference in the clinical efficacy of endoscopy between PPC and WON. 18 , 37 , 51 However, inconsistencies in PFCs differentiation between endoscopists may have been responsible for these negative results. Petrone et al 52 reported that the adverse event rate in the WON group was higher than the PP group.…”