Endoscopic Transgastric Versus Surgical Approach for Infected Necrotizing Pancreatitis: A Systematic Review and Meta-Analysis

Abstract

Surgical approach (SA) is the standard treatment for infected necrotizing pancreatitis (INP) and endoscopic transgastric approach (ETA) is a promising alternative treatment. This systematic review and meta-analysis aimed to compare the effectiveness and safety of ETA versus SA in INP. Several databases were systematically searched for eligible studies that compared ETA with SA for INP. Predefined criteria were used for study selection. Three reviewers independently assessed the risk of bias. Primary outcomes included clinical resolution rate, short-term mortality, major complications, and hospital stay. Study-specific effect sizes and their 95% confidence interval (CI) were combined to calculate the pooled value using fixed-effects or random-effects model. Six studies were included with 295 patients. Major complication rate [odds ratio (OR), 0.13; 95% CI, 0.06-0.29], new-onset organ failure rate (OR, 0.26; 95% CI, 0.12-0.54), postoperative pancreatic fistula rate (OR, 0.09; 95% CI, 0.03-0.28), and incisional hernia rate (OR, 0.10; 95% CI, 0.01-0.85) were lower in the ETA group. There was a shorter hospital stay (mean difference, −17.72; 95% CI, −21.30 to −14.13) in the ETA group. No differences were found in clinical resolution, short-term mortality, postoperative bleeding, perforation of visceral organ, and endocrine or exocrine insufficiency. Compared with SA, ETA showed comparable effectiveness and safety for the treatment of INP based on current evidence.

Outcomes of Endoscopic and Surgical Pancreatic Necrosectomy: A Single Institution Experience

“…[6][7][8] To date, the literature has suggested that open necrosectomy is an inferior treatment modality for proper management of infected necrotizing pancreatitis when compared with less invasive approaches. [9][10][11] However, a lack of consistent analysis and standardization of disease severity has limited the ability to reach a definitive conclusion. Our study aimed to assess patient outcomes after open and endoscopic pancreatic necrosectomy (EPN), thus allowing us to identify the predictors of death and postoperative complications.…”

Guía de práctica clínica para el manejo de la pancreatitis aguda en el seguro social del Perú (Essalud)

“…Por lo tanto, se buscaron estudios que comparen alguna de las intervenciones de interés. De esta manera, encontramos 6 RS publicadas (61)(62)(63)(64)(65)(66) y 1 ECA (60) . Se seleccionó la RS de Ricci 2021 (62) , RS de Haney 2019 (61) y el ECA de Van Sanvoort 2010 (60) por ser las de mayor calidad y las más recientes.…”