Endoscopic and surgical drainage for pancreatic fluid collections are better than percutaneous drainage: Meta-analysis

Lajos Szakó, Péter Mátrai, Péter Hegyi, Dániel Pécsi, Zoltán Gyöngyi, Dezső Csupor, Judit Bajor, Bálint Erőss, Alexandra Mikó, Zsolt Szakács, Dalma Dobszai, Ágnes Meczker, Katalin Márta, Ildikó Rostás, Áron Vincze

Research output: Contribution to journalArticle

Abstract

Background: Pancreatic pseudocyst (PP) and walled-off necrosis can be managed endoscopically, percutaneously or surgically, but with diverse efficacy. Aims & methods: A comprehensive literature search was carried out from inception to December 2018, to identify articles which compared at least two of the three kinds of treatment modalities, regarding the mortality, clinical success, recurrence, complications, cost and length of hospitalisation (LOH). Results: The outcomes of endoscopic (ED) and percutaneous drainage (PD) were comparable in six articles. The clinical success of endoscopic intervention was better considering any types of fluid collections (OR = 3.36; 95% confidence interval (CI) 1.48, 7.63; p = 0.004). ED was preferable regarding recurrence of PP (OR = 0.23; 95% CI 0.08, 0.66; p = 0.006). Fifteen articles compared surgical intervention with ED. Significant difference was found in postoperative LOH (WMD (days) = −4.61; 95%CI -7.89, −1.33; p = 0.006) and total LOH (WMD (days) = −3.67; 95%CI -5.00, −2.34; p < 0.001) which favored endoscopy, but ED had lower rate of clinical success (OR = 0.54; 95% CI 0.35, 0.85; p = 0.007) and higher rate of recurrence (OR = 1.80; 95% CI 1.16, 2.79; p = 0.009) in the treatment of PP. Eleven studies compared surgical and percutaneous intervention. PD resulted in higher rate of recurrence (OR = 4.91; 95% CI 1.82, 13.22; p = 0.002) and lower rate of clinical success (OR = 0.13; 95% CI 0.07, 0.22, p < 0.001). Conclusion: Both endoscopy and surgery are preferable over percutaneous intervention, furthermore endoscopic treatment is associated with shorter hospitalisation than surgery.

Original languageEnglish
JournalPancreatology
DOIs
Publication statusAccepted/In press - Jan 1 2019

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Keywords

  • Endoscopy
  • Pancreatic pseudocyst
  • Pancreatic walled-off necrosis
  • Percutaneous intervention
  • Surgery

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Hepatology
  • Gastroenterology

Cite this

Szakó, L., Mátrai, P., Hegyi, P., Pécsi, D., Gyöngyi, Z., Csupor, D., Bajor, J., Erőss, B., Mikó, A., Szakács, Z., Dobszai, D., Meczker, Á., Márta, K., Rostás, I., & Vincze, Á. (Accepted/In press). Endoscopic and surgical drainage for pancreatic fluid collections are better than percutaneous drainage: Meta-analysis. Pancreatology. https://doi.org/10.1016/j.pan.2019.10.006