Quality of life after surgical and endoscopic management of severe acute pancreatitis: A systematic review

Abstract

BACKGROUND Treatment for severe acute severe pancreatitis (SAP) can significantly affect Health-related quality of life (HR-QoL). The effects of different treatment strategies such as endoscopic and surgical necrosectomy on HR-QoL in patients with SAP remain poorly investigated. AIM To critically appraise the available evidence on HR-QoL following surgical or endoscopic necrosectomy in patient with SAP. METHODS A literature search was performed on PubMed, Google™ Scholar, the Cochrane Library, MEDLINE and Reference Citation Analysis databases for studies that investigated HR-QoL following surgical or endoscopic necrosectomy in patients with SAP. Data collected included patient characteristics, outcomes of interventions and HR-QoL-related details. RESULTS Eleven studies were found to have evaluated HR-QoL following treatment for severe acute pancreatitis including 756 patients. Three studies were randomized trials, four were prospective cohort studies and four were retrospective cohort studies with prospective follow-up. Four studies compared HR-QoL following surgical and endoscopic necrosectomy. Several metrics of HR-QoL were used including Short Form (SF)-36 and EuroQol. One randomized trial and one cohort study demonstrated significantly improved physical scores at three months in patients who underwent endoscopic necrosectomy compared to surgical necrosectomy. One prospective study that examined HR-QoL following surgical necrosectomy reported some deterioration in the functional status of the patients. On the other hand, a cohort study that assessed the long-term HR-QoL following sequential surgical necrosectomy stated that all patients had SF-36 > 60%. In the only study that examined patients following endoscopic necrosectomy, the HR-QoL was also very good. Three studies investigated the quality adjusted life years suggesting that endoscopic and surgical approaches to management of pancreatic necrosis were comparable in cost effectiveness. Finally, regarding HR-QoL between open necrosectomy and minimally invasive approaches, patients who underwent the later had a significantly better overall quality of life, vitality and mental health. CONCLUSION This review would suggest that the endoscopic approach might offer better HR-QoL compared to surgical necrosectomy. However, the available comparative literature was very limited. More randomized trials powered to detect differences in HR-QoL are required.

Endoscopic versus minimally invasive surgical approach for infected necrotizing pancreatitis: a systematic review and meta-analysis of randomized controlled trials

“…The endoscopic procedure re-introduces pancreatic fluid (PF) into the GI tract, preventing electrolytes and fluid loss compared to the MIS procedure, where PF is drained out of the body. According to the findings of a recent study about the quality of life after INP treatment, endoscopic treatment provides a higher overall quality of life in terms of the patient’s health when compared to the surgical method [ 9 ]. The endoscopic technique has been demonstrated to yield the same or comparable results across all of the most recent investigations.…”

Diagnosis, severity stratification and management of adult acute pancreatitis–current evidence and controversies

“…Apart from short-term outcomes, studies have evaluated long-term patient-related outcome measures. A recent systematic review by Psaltis et al [ 127 ] in 2022 included 11 articles which assessed the quality of life (QOL) after endoscopic and/or surgical management of SAP[ 127 ]; literature was heterogenous which rendered inability for pooled analysis. However, the authors suggested that endoscopic management may confer better QOL compared to surgical management based on current literature.…”

Self-Expandable Metal Stent (SEMS) Versus Lumen-Apposing Metal Stent (LAMS) for Drainage of Pancreatic Fluid Collections: A Randomized Clinical Trial

“…The development of therapeutic endoscopic ultrasound (EUS), as well as adequate and dedicated devices, has enabled EUS-guided drainage to become the preferred approach of encapsulated pancreatic collections (EPCs), including pancreatic pseudocysts and walled-off pancreatic necrosis (WON) [3][4][5]. At present, EUSguided drainage is associated with a high clinical efficacy -similar to surgical drainage -but associated with fewer adverse events, reduced morbidity and better quality of life after procedure [6]. While EUS-guided treatment remains a highly effective treatment, there is currently no consensus on the best stent to achieve adequate drainage.…”