Systematic review and meta-analysis of endoscopic ultrasound drainage for the management of fluid collections after pancreas surgery

Ali Ramouz; Saeed Shafiei; Sadeq Ali-Hasan-Al-Saegh; Elias Khajeh; Ricardo Rio-Tinto; Sanam Fakour; Andreas Brandl; Gil Goncalves; Christoph Berchtold; Markus W Büchler; Arianeb Mehrabi

doi:10.1007/s00464-022-09137-6

Systematic review and meta-analysis of endoscopic ultrasound drainage for the management of fluid collections after pancreas surgery

Surg Endosc. 2022 Jun;36(6):3708-3720. doi: 10.1007/s00464-022-09137-6. Epub 2022 Mar 4.

Affiliations

¹ Department of General, Visceral, and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
² Department of Gastroenterology, Digestive Oncology Unit, Champalimaud Foundation, Lisbon, Portugal.
³ Department of Digestive Surgery, Hepato-Pancreato-Biliary Surgery Unit, Champalimaud Foundation, Lisbon, Portugal.
⁴ Department of General, Visceral, and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany. arianeb.mehrabi@med.uni-heidelberg.de.

Abstract

Background: The outcomes of endoscopic ultrasonography-guided drainage (EUSD) in treatment of pancreas fluid collection (PFC) after pancreas surgeries have not been evaluated systematically. The current systematic review and meta-analysis aim to evaluate the outcomes of EUSD in patients with PFC after pancreas surgery and compare it with percutaneous drainage (PCD).

Methods: PubMed and Web of Science databases were searched for studies reporting outcomes EUSD in treatment of PFC after pancreas surgeries, from their inception until January 2022. Two meta-analyses were performed: (A) a systematic review and single-arm meta-analysis of EUSD (meta-analysis A) and (B) two-arm meta-analysis comparing the outcomes of EUSD and PCD (meta-analysis B). Pooled proportion of the outcomes in meta-analysis A as well as odds ratio (OR) and mean difference (MD) in meta-analysis B was calculated to determine the technical and clinical success rates, complications rate, hospital stay, and recurrence rate. ROBINS-I tool was used to assess the risk of bias.

Results: The literature search retrieved 610 articles, 25 of which were eligible for inclusion. Included clinical studies comprised reports on 695 patients. Twenty-five studies (477 patients) were included in meta-analysis A and eight studies (356 patients) were included in meta-analysis B. In meta-analysis A, the technical and clinical success rates of EUSD were 94% and 87%, respectively, with post-procedural complications of 14% and recurrence rates of 9%. Meta-analysis B showed comparable technical and clinical success rates as well as complications rates between EUSD and PCD. EUSD showed significantly shorter duration of hospital stay compared to that of patients treated with PCD.

Conclusion: EUSD seems to be associated with high technical and clinical success rates, with low rates of procedure-related complications. Although EUSD leads to shorter hospital stay compared to PCD, the certainty of evidence was low in this regard.

Keywords: Collection; Drainage; Pancreatectomy; Ultrasonographic drainage.

Publication types

Meta-Analysis
Review
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Drainage
Endosonography*
Humans
Length of Stay
Pancreas / diagnostic imaging
Pancreas / surgery
Pancreatic Diseases* / surgery