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Efficacy and safety of endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD): A systematic review and meta-analysis of 714 patients.

ABSTRACT: Background and study aims? Endoscopic ultrasound guided pancreatic duct drainage (EUS-PDD) is a minimal-invasive therapeutic option to surgery and in patients with failed endoscopic retrograde pancreatography (ERP). The aim of this review was to quantitatively appraise the clinical outcomes of EUS-PDD by meta-analysis methods. Methods? We searched multiple databases from inception through March 2020 to identify studies that reported on EUS-PDD. Pooled rates of technical success, successful drainage of pancreatic duct, clinical success, and adverse events were calculated. Study heterogeneity was assessed using I 2 % and 95?% prediction interval. Results? A total of 22 studies (714 patients) were included. The pooled rate of technical success in EUS-PDD was 84.8?% (95?% CI 79.1-89.2). The pooled rate of successful PD drained by EUS-PDD was 77.5?% (95?% CI 63.1-87.4). The pooled rate of clinical success of EUS-PDD was 89.2?% (95?% CI 82.1-93.7). The pooled rate of all adverse events was 18.1?% (95?% CI 14.2-22.9). On sub-group analysis, the pooled technical success and clinical success of EUS-PDD from Japanese data were considerably superior (91.2?%, 83-95.6 & 92.5?%, 83.9-96.7, respectively). The pooled rate of post EUS-PDD acute pancreatitis was 6.6?% (95?% CI 4.5-9.4), bleeding was 4.1?% (95?% CI 2.7-6.2), perforation and/or pneumoperitoneum was 3.1?% (95?% CI 1.9-5), pancreatic leak and/or pancreatic fluid collection was 2.3?% (95?% CI 1.4-4), and infection was 2.8?% (95?% CI 1.7-4.6). Conclusion? EUS-PDD demonstrates high technical success and clinical success rates with acceptable adverse events. Technical success was especially high for anastomotic strictures.

SUBMITTER: Chandan S

PROVIDER: S-EPMC7581476 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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Efficacy and safety of endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD): A systematic review and meta-analysis of 714 patients.

Chandan Saurabh S Mohan Babu P BP Khan Shahab R SR Kassab Lena L LL Ponnada Suresh S Ofosu Andrew A Bhat Ishfaq I Singh Shailender S Adler Douglas G DG

Endoscopy international open 20201022 11

<b>Background and study aims </b> Endoscopic ultrasound guided pancreatic duct drainage (EUS-PDD) is a minimal-invasive therapeutic option to surgery and in patients with failed endoscopic retrograde pancreatography (ERP). The aim of this review was to quantitatively appraise the clinical outcomes of EUS-PDD by meta-analysis methods. <b>Methods </b> We searched multiple databases from inception through March 2020 to identify studies that reported on EUS-PDD. Pooled rates of technical success, su ...[more]

PMID: 33140022

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Project description:Long term prognosis and 5-year survival for pancreatic adenocarcinoma (PDAC) remains suboptimal. Endoscopic ultrasound (EUS) guided RFA (EUS-RFA) is an emerging technology and limited data exist regarding safety and long-term outcomes. The aim of this study is to report safety-profile, feasibility and outcomes of EUS-RFA for advanced PDAC. Prospective review of patients with diagnosis of locally-advanced or metastatic PDAC undergoing EUS-RFA between October 2016 to March 2018 with long-term follow up (> 30 months). Study patients underwent a total of 1-4 RFA sessions. All patients were enrolled in longitudinal cohort study and received standard of care chemotherapy. 10 patients underwent EUS-RFA. Location of the lesions was in the head(4), neck(2), body(2), and tail(2). 22 RFA sessions were performed with a range of 1-4 sessions per patient. There were no major adverse events (bleeding, perforation, infection, pancreatitis) in immediate (up to 72 h) and short-term follow up (4 weeks). Mild worsening of existing abdominal pain was noted during post-procedure observation in 12/22 (55%) of RFA treatments. Follow-up imaging demonstrated tumor progression in 2 patients, whereas tumor regression was noted in 6 patients (> 50% reduction in size in 3 patients). Median survival for the cohort was 20.5 months (95% CI, 9.93-42.2 months). Currently, 2 patients remain alive at 61 and 81 months follow-up since initial diagnosis. One patient had 3 cm PDAC with encasement of the portal confluence, abutment of the celiac axis, common hepatic and superior mesenteric artery. This patient had significant reduction in tumor size and underwent standard pancreaticoduodenectomy. In our experience, EUS-RFA was safe, well-tolerated and could be concurrently performed with standard chemotherapy. In this select cohort, median survival was improved when compared to published survival based upon SEER database and clinical trials. Future prospective trials are needed to understand the role of EUS-RFA in overall management of PDAC.

Dataset Information

Efficacy and safety of endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD): A systematic review and meta-analysis of 714 patients.

Publications

Efficacy and safety of endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD): A systematic review and meta-analysis of 714 patients.

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