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Endoscopy 2021; 53(03): 266-276
DOI: 10.1055/a-1200-0199
Systematic review

Endoscopic retrograde pancreatography-guided versus endoscopic ultrasound-guided technique for pancreatic duct cannulation in patients with pancreaticojejunostomy stenosis: a systematic literature review

Kirill Basiliya   *
1   Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands
,
Govert Veldhuijzen   *
1   Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands
,
Christian Gerges
2   Department of Internal Medicine II, Evangelisches Krankenhaus (Teaching Hospital of the University of Düsseldorf), Düsseldorf, Germany
,
Johannes Maubach
3   Department of Visceral Surgery and Medicine, Inselspital, University Hospital of Bern, Bern, Switzerland
,
Uwe Will
4   Department of Internal Medicine III, City Hospital, Gera, Germany
,
B. Joseph Elmunzer
  Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, United States
,
Martijn W. J. Stommel
6   Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
,
Reinier Akkermans
7   Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
8   Radboud Institute for Health Sciences, Scientific Institute for Quality of Care, Radboud University Medical Center, Nijmegen, the Netherlands
,
Peter D. Siersema
1   Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands
,
Erwin-Jan M. van Geenen
1   Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands
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Author commentary on Kirill Basiliya et al.Endoscopy 2021; 53(03): v14-v14
DOI: 10.1055/a-1230-5829

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.


Supplementary material



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.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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