Endoscopic versus surgical treatment for pancreatic pseudocysts

Abstract

Objective: This systematic review and meta-analysis aims to compare surgical and endoscopic treatment for pancreatic pseudocyst (PP). Methods: The researchers did a search in Medline, EMBASE, Scielo/Lilacs, and Cochrane electronic databases for studies comparing surgical and endoscopic drainage of PP s in adult patients. Then, the extracted data were used to perform a meta-analysis. The outcomes were therapeutic success, drainage-related adverse events, general adverse events, recurrence rate, cost, and time of hospitalization. Results: There was no significant difference between treatment success rate (risk difference [RD] −0.09; 95% confidence interval [CI] [0.20,0.01]; P = .07), drainage-related adverse events (RD −0.02; 95% CI [−0.04,0.08]; P = .48), general adverse events (RD −0.05; 95% CI [−0.12, 0.02]; P = .13) and recurrence (RD: 0.02; 95% CI [−0.04,0.07]; P = .58) between surgical and endoscopic treatment. Regarding time of hospitalization, the endoscopic group had better results (RD: −4.23; 95% CI [−5.18, −3.29]; P < .00001). When it comes to treatment cost, the endoscopic arm also had better outcomes (RD: −4.68; 95% CI [−5.43,−3.94]; P < .00001). Conclusion: There is no significant difference between surgical and endoscopic treatment success rates, adverse events and recurrence for PP. However, time of hospitalization and treatment costs were lower in the endoscopic group.

Recurrent Pancreatic Pseudocysts Due to Alcohol-Related Chronic Pancreatitis With Double-Duct Sign and Spontaneous Rupture

“…EUS-guided drainage and surgical drainage have almost equal efficacy and outcome, with similar rates of success and recurrence. EUS is less invasive, less costly, and associated with a shorter hospital stay and more rapid recovery [14][15][16][17].…”

Role of pancreatography in the endoscopic management of encapsulated pancreatic collections – review and new proposed classification

“…It is well established that EUS-guided transmural drainage is the gold standard approach for both pseudocyst and WON[ 4 , 5 ]. Thus, pancreatography classifications that attempt to guide the best approach – surgery, percutaneous drainage, or endoscopic drainage - no longer have clinical relevance.…”

“…More recently, the development of endoscopic drainage using endoscopic ultrasound (EUS) to achieve successful transmural drainage has overcome many complications related to surgery and percutaneous drainage and has demonstrated improved efficacy safety compared to more invasive approaches. At this time, endoscopic treatment of EPCs has become the first-line therapy for both pseudocyst and WON, when technically feasible[ 4 , 5 ].…”

Current status of treatments of pancreatic and peripancreatic collections of acute pancreatitis

“…Furthermore, patients in the endoscopic treatment group were associated with a shorter hospital stay, lower cost, and better physical and mental status[ 16 - 18 ]. A systematic review contained six comparative studies of 342 patients, which confirmed that there were no significant differences in the treatment success rates, adverse events, and recurrence rates between surgery and endoscopic treatments, but the endoscopic group had shorter hospital stays and lower treatment costs[ 19 ]. When it comes to the comparison between laparoscopic surgery and endoscopic drainage, both techniques were similar in terms of mortality, overall success rate, recurrence rate, and postoperative complications[ 20 ].…”