Endoscopic pancreatic duct stenting for pain palliation in selected pancreatic cancer patients: a systematic review and meta-analysis

Abstract

Background Abdominal pain is a debilitating symptom affecting ∼80% of pancreatic cancer (PC) patients. Pancreatic duct (PD) decompression has been reported to alleviate this pain, although this practice has not been widely adopted. We aimed to evaluate the role, efficacy, and safety of endoscopic PD decompression for palliation of PC post-prandial obstructive-type pain. Methods A systematic review until 7 October 2020 was performed. Two independent reviewers selected studies, extracted data, and assessed the methodological quality. Results We identified 12 publications with a total of 192 patients with PC presenting with abdominal pain, in whom PD decompression was attempted, and was successful in 167 patients (mean age 62.5 years, 58.7% males). The use of plastic stents was reported in 159 patients (95.2%). All included studies reported partial or complete improvement in pain levels after PD stenting, with an improvement rate of 93% (95% confidence interval, 79%–100%). The mean duration of pain improvement was 94 ± 16 days. Endoscopic retrograde cholangiopancreatography (ERCP)-related adverse events (AEs) were post-sphincterotomy bleeding (1.8%), post-ERCP pancreatitis (0.6%), and hemosuccus pancreaticus (0.6%). AEs were not reported in two patients who underwent endoscopic ultrasound-guided PD decompression. In the 167 patients with technical success, the stent-migration and stent-occlusion rates were 3.6% and 3.0%, respectively. No AE-related mortality was reported. The methodological quality assessment showed the majority of the studies having low or unclear quality. Conclusion In this exploratory analysis, endoscopic PD drainage may be an effective and safe option in selected patients for the management of obstructive-type PC pain. However, a randomized–controlled trial is needed to delineate the role of this invasive practice.

Liver chemistries in glycogenic hepatopathy associated with type 1 diabetes mellitus: A systematic review and pooled analysis

“…The same two reviewers assessed the methodological quality of included studies with a discussion between them in case of disagreement. This tool has been previously applied with consistent agreement among reviewers in several studies 19‐27 …”

The learning experience for endoscopic submucosal dissection in a non-academic western hospital: a single operator’s untutored, prevalence-based approach

“…We relied on a widely-used tool to provide a quality assessment of the risk of bias in our reported case series [ 19 ]. This tool has been applied in previous studies, with consistency among reviewers [ 20 - 25 ]. All patients represented the whole experience of the operator during the study period, and case inclusion was not biased (all qualified patients were included without omission).…”

Contamination of Single Fluid-Filled Intragastric Balloons with Orogastric Fluid is not Associated with Hyperinflation: An Ex-vivo Study and Systematic Review of Literature

“…This resulted in a ve-item tool to assess whether the methodological quality of the included studies is good, unclear, or low based on three possible answer for each item (yes, cannot tell, no). This tool has been previously applied with consistency among reviewers [18][19][20][21][22].…”

“…19)]. The sterile saline group (A1, A2) trended to display a higher nal mean diameter when compared to the other groups with OG contaminants[29.3 cm ± 0.4 cm versus 28.3 cm + 1.3 cm (p = 0.07)].…”