Is Endoscopic Drainage Better than Percutaneous Drainage for Patients with Pancreatic Fluid Collections? A Comparative Meta-Analysis

Cai, Qi; Zhang, Jintao; Liao, Yang; Gong, Jian Ping; Xiong, Bin

doi:10.17235/reed.2020.7170/2020

Cited by 4 publications

(4 citation statements)

References 35 publications

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“…Cai et al. [ 35 ] reported a data of 11 studies meta-analysis with OR for clinical success of 1.39 (95% CI 0.82, 2.37) that is in favour of ED and included studies with missing outcome data. But the current study included 17 studies all reporting our primary outcome clinical success.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of endoscopic drainage versus percutaneous drainage for pancreatic fluid collection; a systematic review and meta-analysis

et al. 2023

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Background/Aims Pancreatic fluid collections (PFC) are debris or fluid of the pancreas that needs to be drained out. This may result from surgery or necrotizing pancreatitis. This meta-analysis compared the outcomes of PFC through endoscopic and percutaneous interventions. Methods A medical database was searched up to June 2022, comparing the outcomes of endoscopic drainage (ED) and percutaneous drainage (PD) for the PFC. Eligible studies reporting clinical and technical success and adverse events were selected. Results Seventeen studies with 1170 patients were included for meta-analysis, of which 543 patients underwent ED and 627 underwent PD. The odd ratio (OR) of technical success was 0.81 (95% confidence interval (CI) 0.31, 2.1) and clinical success was in the favor of the ED group at OR 2.23 (95% CI 1.45, 3.41). Adverse events OR 0.62 (95% CI 0.27, 1.39) and stent migration OR 0.61 (95% CI 0.10, 3.88) were the same in both groups, but hospital stay pooled mean difference of 15.02 days (95% CI 9.86, 20.18), mortality OR 0.24 (95% CI 0.09, 0.67), and re-interventions OR 0.25 (95% CI 0.16, 0.40) favored ED. Conclusions ED is safe and efficient for PFC with higher clinical success, lower mortality rate, hospital stay, and re-interventions compared with PD.

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Section: Discussionmentioning

confidence: 99%

Efficacy and safety of endoscopic drainage versus percutaneous drainage for pancreatic fluid collection; a systematic review and meta-analysis

et al. 2023

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“…Endoscopic step‐up approach was associated with reduced inpatient length of stay (LOS) and pancreatic fistula formation but similar mortality 5 . This same reduction in LOS was further supported by a meta‐analysis comparing endoscopic versus percutaneous drainage 6 . Endoscopic drainage was also found to have shorter LOS but required more re‐intervention in comparison to laparoscopic drainage 7,8 .…”

Section: Introductionmentioning

confidence: 87%

“…5 This same reduction in LOS was further supported by a meta-analysis comparing endoscopic versus percutaneous drainage. 6 Endoscopic drainage was also found to have shorter LOS but required more re-intervention in comparison to laparoscopic drainage. 7,8 Based on endoscopic step-up approach, protocolised endoscopic necrosectomy after primary drainage has been reported.…”

Section: Introductionmentioning

confidence: 93%

Repetitive endoscopic drainage as initial intervention is safe and effective for early treatment of pancreatic necrotic collections

Ma,

Ong,

Hew

et al. 2024

ANZ Journal of Surgery

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BackgroundWhile endoscopic step‐up approach with delayed drainage (more than 28 days from diagnosis) was shown to produce the best outcomes in the treatment of pancreatic walled‐off necrosis (WON), we assessed our single centre experience of early versus delayed endoscopic drainage of pancreatic necrotic collections.MethodsPatients who underwent endoscopic drainage of pancreatic necrotic collections between 2011 and 2022 under Monash Health were identified. They were excluded if below 18 years old or their follow up data were missing. The included patients' medical records, pathology results, and imaging findings were retrospectively reviewed.ResultsA total of 60 patients were included. 31.58% required percutaneous drainage and 15% received either endoscopic or surgical necrosectomy. The disease related mortality was 8.47% and the average length of stay (LOS) was 70.92 days. No significant difference was shown in disease‐related mortality (10.5% vs. 7.5%, P = 0.697) or LOS (75.35 vs. 68.7, P = 0.644) between early and delayed drainage cohorts, but patients who received early drainage have higher qSOFA score on the day of drainage (2 vs. 0, P = 0.004).DiscussionRepetitive endoscopic drainage with selective percutaneous drainage is effective in the management of pancreatic necrotic collections. Early drainage should be considered in patients who developed severe sepsis.

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“…Both can require intervention if they become symptomatic. There have been several studies comparing endoscopic management to either surgical or percutaneous drainage, with most concluding in the superiority of endoscopic management in terms of efficacy and safety 3 4 5 6 7 8 .…”

Section: Introductionmentioning

confidence: 99%

Safety and efficacy of early versus late removal of LAMS for pancreatic fluid collections

Willems,

Esmail,

Paquin

et al. 2023

Endosc Int Open

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Background and Study Aims: Optimal timing for removal of lumen-apposing metal stents (LAMS) for effective drainage of pancreatic fluid collections (PFC) while minimizing adverse events (AE) is unknown. Outcomes of early (≤ 4 weeks) or delayed (> 4 weeks) LAMS removal on both clinical efficacy and the incidence of AE were assessed. Patients and methods: This is a retrospective analysis of a prospectively maintained registry of PFC drainage between November 2016 and September 2021. Clinical success was defined as a 75% decrease in fluid collection volume, with no need for reintervention at 6 months. AE were defined using ASGE lexicon. Multiple logistic regression analysis was performed to determine variables associated with clinical success and AE. Results: 108 consecutive PFC were included. LAMS deployment was technically successful in 103/108 (95.4%) of cases. Failure was associated with collection diameter ≤4 cm (OR 24.0, p=0.005) and presence of more than 50% necrotic material (OR 20.1, p=0.01). Stents were left in place for a median of 48 days. Patients with early stent removal (< 4 weeks) had clinical success in 70.0% of cases, which was significantly less than in the group with delayed stent removal (96.4%, p=0.03). On multiple regression analysis, clinical failure was associated with early stent removal (OR 25.5, p=0.003). AE occurred in 8.7% of cases (9/103). There were no predictors of AE. Notably, delayed stent removal did not predict the occurrence of AE. Conclusions: Early LAMS removal (<4 weeks) did not prevent AE but did lead to increased clinical failure.

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Is Endoscopic Drainage Better than Percutaneous Drainage for Patients with Pancreatic Fluid Collections? A Comparative Meta-Analysis

Cited by 4 publications

References 35 publications

Efficacy and safety of endoscopic drainage versus percutaneous drainage for pancreatic fluid collection; a systematic review and meta-analysis

Efficacy and safety of endoscopic drainage versus percutaneous drainage for pancreatic fluid collection; a systematic review and meta-analysis

Repetitive endoscopic drainage as initial intervention is safe and effective for early treatment of pancreatic necrotic collections

Safety and efficacy of early versus late removal of LAMS for pancreatic fluid collections

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