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CC BY-NC-ND 4.0 · Endosc Int Open 2018; 06(04): E474-E483
DOI: 10.1055/s-0044-102299
Original article
Owner and Copyright © Georg Thieme Verlag KG 2018

Endoscopic versus percutaneous management for symptomatic pancreatic fluid collections: a systematic review and meta-analysis

Muhammad Ali Khan   *
1   Division of Gastroenterology, University of Tennessee Health Science Center, Memphis, TN, USA
,
Tariq Hammad   *
2   Division of Gastroenterology, Baylor College of Medicine, Houston, TX, USA
,
Zubair Khan
3   Division of Gastroenterology, University of Toledo, Toledo, OH, USA
,
Wade Lee
4   Mulford and Carlson Libraries, University of Toledo, Toledo, OH, USA
,
Monica Gaidhane
5   Department of Medicine – Rutgers Robert Wood Johnson Medical School Rutgers, The State University of New Jersey, Robert Wood Johnson University Hospital
,
Amy Tyberg
5   Department of Medicine – Rutgers Robert Wood Johnson Medical School Rutgers, The State University of New Jersey, Robert Wood Johnson University Hospital
,
Michel Kahaleh
5   Department of Medicine – Rutgers Robert Wood Johnson Medical School Rutgers, The State University of New Jersey, Robert Wood Johnson University Hospital
› Author Affiliations
Further Information

Publication History

submitted 05 December 2017

accepted after revision 25 January 2018

Publication Date:
29 March 2018 (online)

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Abstract

Background Symptomatic pancreatic fluid collections (PFCs) are managed by surgical, percutaneous, or endoscopic drainage. Due to morbidity associated with surgical drainage, percutaneous and/or endoscopic options have increasingly been used as initial management.

Aims We conducted a systematic review and meta-analysis comparing the efficacy and safety of endoscopic versus percutaneous drainage for management of PFCs.

Methods We searched several databases from inception through 31 August 2017 to identify comparative studies using endoscopic or percutaneous drainage for PFCs. Our primary outcome was clinical success. Secondary outcomes were technical success, adverse events (AE), rates of recurrence, requirement for subsequent procedures, and length of stay in hospital. Pooled risk ratios (RR) and mean difference (MD) were calculated for categorical and continuous outcomes, respectively.

Results Seven studies with 490 patients were included in the final analysis. Pooled RR for clinical success was 0.40 (0.26, 0.61), I 2 = 42 % in favor of endoscopic management. On sensitivity analysis, after excluding one study on patients with walled-off necrosis (WON), the clinical success was 0.43 (0.28, 0.66) with no heterogeneity. Pooled RR for technical success was 1.50 (0.52, 4.37) with no heterogeneity. Pooled RR for AE and rate of recurrence were 0.77 (0.46, 1.28) and 0.60 (0.29, 1.24), respectively. Pooled MD for length of stay in hospital and rate of re-intervention were – 8.97 (– 12.88, – 5.07) and – 0.66 (– 0.93, – 0.38), respectively, in favor of endoscopic drainage.

Conclusions Endoscopic drainage should be the preferred therapeutic modality for PFCs compared to percutaneous drainage as it is associated with significantly better clinical success, a lower re-intervention rate, and a shorter hospital length of stay.

This study was presented as an abstract at Digestive Disease Week 2017 in Chicago, USA.

* Authors contributed equally to the manuscript.


 

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