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DOI: 10.1055/a-1200-0199
Endoscopic retrograde pancreatography-guided versus endoscopic ultrasound-guided technique for pancreatic duct cannulation in patients with pancreaticojejunostomy stenosis: a systematic literature review
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Abstract
Background Stenosis of the pancreaticojejunostomy is a well-known long-term complication of pancreaticoduodenectomy. Traditionally, the endoscopic approach consisted of endoscopic retrograde pancreatography (ERP). Endoscopic ultrasound (EUS)-guided intervention has emerged as an alternative, but the success rate and adverse event rate of both treatment modalities are poorly known. We aimed to compare the outcome data of both interventions.
Methods We performed a systematic literature search using the Pubmed/Medline and Embase databases in order to summarize the available data regarding efficacy and complications of ERP- and EUS-guided pancreatic duct (PD) drainage and compare these outcome data using uniform outcome measures in a multilevel logistic model.
Results 13 studies were included, involving 77 patients who underwent ERP-guided drainage, 145 who underwent EUS-guided drainage, and 12 patients who underwent both modalities. An EUS-guided approach was significantly superior to an ERP-guided approach with regard to pancreatic duct opacification (87 % vs. 30 %; P < 0.001), cannulation success (79 % vs. 26 %; P < 0.001), and stent placement (72 % vs. 20 %; P < 0.001). An EUS-guided approach also appeared superior with regard to clinical outcomes such a pain resolution. The adverse event rate between the two treatment modalities could not be compared due to insufficient data. All included studies were found to be of low quality.
Conclusion Based on limited available data, EUS-guided PD intervention appears superior to ERP-guided PD intervention.
* These authors contributed equally to this work.
Publication History
Received: 18 January 2020
Accepted: 15 June 2020
Accepted Manuscript online:
15 June 2020
Article published online:
11 September 2020
© 2020. Thieme. All rights reserved.
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References
- 1 Morgan KA, Fontenot BB, Harvey NR. et al. Revision of anastomotic stenosis after pancreatic head resection for chronic pancreatitis: is it futile?. HPB (Oxford) 2010; 12: 211-216
- 2 Cioffi JL, McDuffie LA, Roch AM. et al. Pancreaticojejunostomy stricture after pancreatoduodenectomy: outcomes after operative revision. J Gastrointest Surg 2016; 20: 293-299
- 3 Demirjian AN, Kent TS, Callery MP. et al. The inconsistent nature of symptomatic pancreatico-jejunostomy anastomotic strictures. HPB (Oxford) 2010; 12: 482-487
- 4 Farrell J, Carr-Locke D, Garrido T. et al. Endoscopic retrograde cholangiopancreatography after pancreaticoduodenectomy for benign and malignant disease: indications and technical outcomes. Endoscopy 2006; 38: 1246-1249
- 5 Chahal P, Baron TH, Topazian MD. et al. Endoscopic retrograde cholangiopancreatography in post-Whipple patients. Endoscopy 2006; 38: 1241-1245
- 6 Kinney TP, Li R, Gupta K. et al. Therapeutic pancreatic endoscopy after Whipple resection requires rendezvous access. Endoscopy 2009; 41: 898-901
- 7 Kikuyama M, Itoi T, Ota Y. et al. Therapeutic endoscopy for stenotic pancreatodigestive tract anastomosis after pancreatoduodenectomy (with videos). Gastrointest Endosc 2011; 73: 376-382
- 8 Yane K, Katanuma A, Maguchi H. et al. Short-type single-balloon enteroscope-assisted ERCP in postsurgical altered anatomy: potential factors affecting procedural failure. Endoscopy 2017; 49: 69-74
- 9 Park BK, Jeon TJ, Jayaraman V. et al. Endoscopic retrograde cholangiopancreatography in patients with previous pancreaticoduodenectomy: a single-center experience. Dig Dis Sci 2016; 61: 293-302
- 10 François E, Kahaleh M, Giovannini M. et al. EUS-guided pancreaticogastrostomy. Gastrointest Endosc 2002; 56: 128-133
- 11 Liberati A, Altman DG, Tetzlaff J. et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med 2009; 151: W65-94
- 12 Ouzzani M, Hammady H, Fedorowicz Z. et al. Rayyan-a web and mobile app for systematic reviews. Syst Rev 2016; 5: 210
- 13 Slim K, Nini E, Forestier D. et al. Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 2003; 73: 712-716
- 14 Kurihara T, Itoi T, Sofuni A. et al. Endoscopic ultrasonography-guided pancreatic duct drainage after failed endoscopic retrograde cholangiopancreatography in patients with malignant and benign pancreatic duct obstructions. Dig Endosc 2013; 25 (Suppl. 02) 109-116
- 15 Matsushita M, Takakuwa H, Uchida K. et al. Techniques to facilitate ERCP with a conventional endoscope in patients with previous pancreatoduodenectomy. Endoscopy 2009; 41: 902-906
- 16 Tessier G, Bories E, Arvanitakis M. et al. EUS-guided pancreatogastrostomy and pancreatobulbostomy for the treatment of pain in patients with pancreatic ductal dilatation inaccessible for transpapillary endoscopic therapy. Gastrointest Endosc 2007; 65: 233-241
- 17 Kahaleh M, Hernandez AJ, Tokar J. et al. EUS-guided pancreaticogastrostomy: analysis of its efficacy to drain inaccessible pancreatic ducts. Gastrointest Endosc 2007; 65: 224-230
- 18 Barkay O, Sherman S, McHenry L. et al. Therapeutic EUS-assisted endoscopic retrograde pancreatography after failed pancreatic duct cannulation at ERCP. Gastrointest Endosc 2010; 71: 1166-1173
- 19 Ergun M, Aouattah T, Gillain C. et al. Endoscopic ultrasound-guided transluminal drainage of pancreatic duct obstruction: long-term outcome. Endoscopy 2011; 43: 518-525
- 20 Fujii LL, Topazian MD, Abu Dayyeh BK. et al. EUS-guided pancreatic duct intervention: outcomes of a single tertiary-care referral center experience. Gastrointest Endosc 2013; 78: 854-864.e1
- 21 Tyberg A, Sharaiha RZ, Kedia P. et al. EUS-guided pancreatic drainage for pancreatic strictures after failed ERCP: a multicenter international collaborative study. Gastrointest Endosc 2017; 85: 164-169
- 22 Chen Y-I, Levy MJ, Moreels TG. et al. An international multicenter study comparing EUS-guided pancreatic duct drainage with enteroscopy-assisted endoscopic retrograde pancreatography after Whipple surgery. Gastrointest Endosc 2017; 85: 170-177
- 23 Gooiker GA, Lemmens VEPP, Besselink MG. et al. Impact of centralization of pancreatic cancer surgery on resection rates and survival. Br J Surg 2014; 101: 1000-1005
- 24 Conroy T, Hammel P, Hebbar M. et al. FOLFIRINOX or gemcitabine as adjuvant therapy for pancreatic cancer. N Engl J Med 2018; 379: 2395-2406