The outcomes of initial endoscopic transluminal drainage are superior to percutaneous drainage for patients with infected pancreatic necrosis: a prospective cohort study

He, Wenhua; Zhu, Yong; Zhu, Yin; Pi, Li; Zeng, Hao; Xia, Liang; Chen, Yu; Chen, Haiming; Shu, Xu; Liu, Zhijian; Chen, Youxiang; Lü, Nonghua

doi:10.1007/s00464-016-5324-9

Cited by 24 publications

(31 citation statements)

References 25 publications

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“…Other authors have noted that the relatively large variations in reported complication rates in these studies may be partially attributable to the different definitions of complications or in the length of follow-up 17 . The definition of WON resolution, which not only differed between studies but also in terms of the timeframe in which resolution was assessed, ranged from ≤ 4 weeks 28 in some studies to > 1 year in others 34 . In addition, WON size reporting was not standardized, with some studies reporting the length of the longest axis of the WON, and other studies not specifying the dimension being reported.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of lumen-apposing metal stents versus plastic stents to treat walled-off pancreatic necrosis: systematic review and meta-analysis

et al. 2020

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Background and study aims Lumen-apposing metal stents (LAMS) are increasingly used for drainage of walled-off pancreatic necrosis (WON). Recent studies suggested greater adverse event (AE) rates with LAMS for WON. We conducted a systematic review and meta-analysis to compare the safety and efficacy of LAMS with double-pigtail plastic stents (DPPS) for endoscopic drainage of WON. The primary aim was to evaluate stent-related AEs. Methods In October 2019, we searched the Ovid (Embase, MEDLINE, Cochrane) and Scopus databases for studies assessing a specific LAMS or DPPS for WON drainage conducted under EUS guidance. Safety outcomes were AE rates of bleeding, stent migration, perforation, and stent occlusion. Efficacy outcomes were WON resolution and number of procedures needed to achieve resolution. A subanalysis including non-EUS-guided cases was performed. Results Thirty studies including one randomized controlled trial (total 1,524 patients) were analyzed. LAMS were associated with similar bleeding (2.5 % vs. 4.6 %, P = 0.39) and perforation risk (0.5 % vs. 1.1 %, P = 0.35) compared to DPPS. WON resolution (87.4 % vs. 87.5 %, P = 0.99), number of procedures to achieve resolution (2.09 vs. 1.88, P = 0.72), stent migration (5.9 % vs. 6.8 %, P = 0.79), and stent occlusion (3.8 % vs. 5.2 %, P = 0.78) were similar for both groups. Inclusion of non-EUS-guided cases led to significantly higher DPPS bleeding and perforation rates. Conclusions LAMS and DPPS were associated with similar rates of AEs and WON resolution when limiting analysis to EUS-guided cases. Higher bleeding rates were seen in historical studies of DPPS without EUS guidance. Additional high-quality studies of WON treatment using consistent outcome definitions are needed.

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Section: Discussionmentioning

confidence: 99%

Safety and efficacy of lumen-apposing metal stents versus plastic stents to treat walled-off pancreatic necrosis: systematic review and meta-analysis

et al. 2020

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“…After reviewing the title and abstract of the remaining 53 studies, only 14 full-text studies were evaluated for further assessment, and five records were excluded due to incomplete data. Eventually, 9 clinical studies were consistent with the inclusion requirements (17)(18)(19)(20)(21)(22)(23)(24)(25). A detailed study flow-diagram is shown in Fig.…”

Section: Included Trial Characteristics and Quality Assessmentmentioning

confidence: 80%

“…Five included studies (17)(18)(19)(20)24) provided data on endocrine insufficiency, which included 82 cases in the endoscopic approach group and 87 cases in the MIS group. Twelve out of 82 (15.85%) patients who underwent the endoscopic procedure were diagnosed with new-onset diabetes, whereas 27 out of 87 (31.03%) patients who underwent the MIS procedure were diagnosed.…”

Section: Long-term Outcomes: New-onset Diabetes Exocrine Insufficiencymentioning

confidence: 99%

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Endoscopic or minimally invasive surgical approach for infected necrotizing pancreatitis: a systematic review and meta-analysis.

Zhao

et al. 2018

IJMSCI

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Background and Aim: The incidence of acute pancreatitis is rising around the world, thus further increasing the burden on healthcare services. Approximately 10% of patients with acute pancreatitis will develop infected necrotizing pancreatitis, which is the leading cause of high mortality in the late phase. There is currently no consensus with regard to the use of endoscopic or minimally invasive surgical as the first-line therapy of choice for infected necrotizing pancreatitis. However, more clinical research regarding the superiority of the endoscopic approach has been published recently. Therefore, we conducted a systematic review and meta-analysis to determine which of the two treatments leads to a better prognosis. Methods: Four databases (Medline, SinoMed, EMBASE, and Cochrane Library) were searched for eligible studies from 1980 to 2018 comparing endoscopic and minimally invasive surgical for infected necrotizing pancreatitis. Results: Two RCTs and seven clinical cohort studies were included. After the analysis of data amenable to polling, significant advantages were found in favor of the endoscopic approach in terms of pancreatic fistula (OR=0.10, 95%CI 0.04-0.30, P<0.001)and length of hospital stay (WMD=-24.72, 95%CI=-33.87 to-15.57, P<0.001). No marked differences were found in terms of mortality, multiple organ failure, intra-abdominal bleeding, enterocutaneous fistula, recurrence of pseudocysts, length of stay in the ICU, endocrine insufficiency and exocrine insufficiency. Conclusion: Compared with minimally invasive surgical, endoscopic remedy evidently improved short-term outcomes for infected necrotizing pancreatitis, including pancreatic fistula and length of hospital stay. Furthermore, relevant multicenter RCTs are eager to prove these findings.

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“…Therefore, in this study, the series included a high proportion of tertiary referrals (85.1%), which was also higher than other high-volume specialist centers [1]. Since the extremely high referral rate, the interval between onset of disease and initial surgical treatment was longer than other centers [1,10,17,18]. Percutaneous or endoscopic drainage was the first step in surgical step-up approach, and many patients were transferred to our hospital after failure of drainage.…”

Section: Discussionmentioning

confidence: 99%

One-Step verse Step-Up Laparoscopic-Assisted Necrosectomy for Infected Pancreatic Necrosis

et al. 2019

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Background: Percutaneous or endoscopic drainage was usually performed as the first step in step-up approach for infected pancreatic necrosis (IPN). However, drainage was unnecessary or unavailable in some patients. Objective: To estimate the safety and effect of one-step laparoscopic-assisted necrosectomy in IPN patients. Methods: A retrospective analysis of IPN patients received surgical therapy in our center between January 2015 and December 2017 was performed. Patients were assigned to either one-step or step-up groups according to the received therapeutic approach. Incidence of complications, death, total number of interventions, and total hospital stay were compared. Logistic regression and nomogram were used to explore the risk factors and probability for patients undergoing interventions ≥3 times. Results: There were 45 and 49 patients included in one-step and step-up groups, respectively. No significant difference between groups in terms of new organ failure (14.29 vs. 14.33%, p = 0.832), death (8.89 vs.8.17%, p = 0.949), and long-term complications (18.37 vs. 15.56%, p = 0.717). However, the number of interventions in one-step group was significantly less than in step-up group with shorter hos-pital stay. After multivariate analysis, C-reactive protein, interleukin-6, and surgical approach were independent predicators for patients undergoing interventions ≥3. A nomogram was built with area under ROC curve 0.891. Conclusion: Compared with step-up approach, one-step surgery was safe and effective in selected IPN patients with less interventions and shorter hospital stay.

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The outcomes of initial endoscopic transluminal drainage are superior to percutaneous drainage for patients with infected pancreatic necrosis: a prospective cohort study

Abstract: The outcomes of initial endoscopic transluminal drainage are superior to percutaneous drainage for patients with infected pancreatic necrosis (ChiCTR-ONRC-13003653).

Cited by 24 publications

References 25 publications

Safety and efficacy of lumen-apposing metal stents versus plastic stents to treat walled-off pancreatic necrosis: systematic review and meta-analysis

Safety and efficacy of lumen-apposing metal stents versus plastic stents to treat walled-off pancreatic necrosis: systematic review and meta-analysis

Endoscopic or minimally invasive surgical approach for infected necrotizing pancreatitis: a systematic review and meta-analysis.

One-Step verse Step-Up Laparoscopic-Assisted Necrosectomy for Infected Pancreatic Necrosis

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