Endoscopic ultrasound-guided versus conventional transmural techniques have comparable treatment outcomes in draining pancreatic pseudocysts

Abstract

We carried out the first meta-analysis comparing the technical success and clinical outcomes of endoscopic ultrasound-guided drainage (EUD) and conventional transmural drainage (CTD) for pancreatic pseudocysts. We searched PubMed, Embase, Scopus, and the Cochrane library to identify relevant prospective trials. The technical success rate, short-term (4-6 weeks) success, and long-term (at 6 months) success in symptoms and the radiologic resolution of pseudocysts, complication rates, and death rates were compared. Two eligible randomized-controlled trials and two prospective studies including 229 patients were retrieved. The technical success rate was significantly higher for EUD than for CTD [risk ratio (RR)=12.38, 95% confidence interval (CI): 1.39-110.22]. When CTD failed because of the nonbulging nature of pseudocysts, a crossover was carried out to EUD (n=18), which was successfully performed in all these cases. All patients with portal hypertension and bleeding tendency were subjected to EUD to avoid severe complications. EUD was not superior to CTD in terms of short-term success (RR=1.03, 95% CI: 0.95-1.11) or long-term success (RR=0.98, 95% CI: 0.76-1.25). The overall complications were similar in both groups (RR=0.98, 95% CI: 0.52-1.86). The most common complications were bleeding and infection. There were two deaths from bleeding after CTD. The short-term and long-term treatment success of both methods is comparable only if proper drainage modality is selected in specific clinical situations. For bulging pseudocysts, either EUD or CTD can be selected whereas EUD is the treatment of choice for nonbulging pseudocysts, portal hypertension, or coagulopathy.

Endoscopic Ultrasound-Guided Transluminal Drainage for Peripancreatic Fluid Collections: Where Are We Now?

“…However, for nonluminal bulging PPs or if CTD or TPD has failed, EUS-TD has the theoretical advantage of reducing the risk of bleeding, perforation, and infection compared with CTD. The first meta-analysis comparing the technical success and clinical outcomes of EUS-TD and CTD for PPs resulted in the same conclusion 15. Utilizing EUS-TD for PP has been shown to be the safest.…”

Safety and Efficacy of Endoscopic Ultrasound-Guided Drainage of Pancreatic Fluid Collections With Lumen-Apposing Covered Self-Expanding Metal Stents

“…3,13,15,29 However, the migration rates, the smaller diameter, and the need for repeat guidewire access through the enterostomy for multiple stent placements, has necessitated alternative options such as placing metal stents to permit efficient drainage. Talreja et al 13 published a study on the efficacy of using fully covered metal stents with fins to drain PFCs.…”

Endoscopic ultrasound guided drainage of pancreatic fluid collections: Assessment of the procedure, technical details and review of the literature

“…Panamonta et al [54] reported a meta-analysis of (2 randomized-controlled trials and two prospective studies, 229 patients) comparing conventional transmural drainage and EUS guided drainage They found that the technical success rate was significantly higher for EUS group than for conventional drainage group (RR = 12.38, 95%CI: 1. 39-110.22).…”