Clin Endosc.  2017 Jul;50(4):388-394. 10.5946/ce.2016.091.

There Is No Advantage to Transpapillary Pancreatic Duct Stenting for the Transmural Endoscopic Drainage of Pancreatic Fluid Collections: A Meta-Analysis

• Amin S
• Yang DJ
• Lucas AL
• Gonzalez S
• DiMaio CJ

• KMID: 2389245
• DOI: http://doi.org/10.5946/ce.2016.091

Abstract

BACKGROUND/AIMS
Options for the endoscopic management of symptomatic pancreatic fluid collections (PFCs) include transmural drainage (TM) alone, transpapillary drainage (TP) alone, or a combination of both drainage method (CD). There have been conflicting reports about the best method. This study performed a meta-analysis to determine whether CD presents an added clinical benefit over TM.
METHODS
The included studies compared TM with CD and reported clinical success for both methods. A random-effects model was used to determine the pooled odds ratios (ORs) and the 95% confidence intervals (CIs) for the following outcomes: technical success, clinical success, complications, and recurrence.
RESULTS
Nine studies involving a combined total of 604 drainage procedures"”373 TMs (62%) and 231 CDs (38%)"”were included. CD showed no additional benefit over TM in terms of technical success (OR, 1.12; 95% CI, 0.37-3.37; p=0.85), clinical success (OR, 1.11; 95% CI, 0.65-1.89; p=0.70), recurrence (OR, 1.49; 95% CI, 0.53-4.21; p=0.45), or complications (OR, 1.15; 95% CI, 0.61-2.18; p=0.67).
CONCLUSIONS
Pancreatic duct (PD) stenting provides no additional clinical benefit for the TM of PFCs (particularly pseudocysts). Patients undergoing the TM of symptomatic pseudocysts may not require endoscopic retrograde pancreatography (ERP).

Keyword

Pancreatic pseudocyst; Drainage; Endoscopy; Pancreatic fluid collection; Endoscopic retrograde pancreatography

MeSH Terms

Drainage*
Endoscopy
Humans
Methods
Odds Ratio
Pancreatic Ducts*
Pancreatic Pseudocyst
Recurrence
Stents*

Figure

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  Fig. 1. Flow diagram of studies included in the meta-analysis.

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  Fig. 2. Technical success of transmural alone vs. combined drainage of pancreatic fluid collections (PFCs). OR, odds ratio; CI, confidence interval; CD, combination of both drainage method; TM, transmural drainage.

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  Fig. 3. Clinical success of transmural alone vs. combined drainage of pancreatic fluid collections (PFCs). OR, odds ratio; CI, confidence interval; CD, combination of both drainage method; TM, transmural drainage.

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  Fig. 4. Recurrence rate of transmural alone vs. combined drainage of pancreatic fluid collections (PFCs). OR, odds ratio; CI, confidence interval; CD, combination of both drainage method; TM, transmural drainage.

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  Fig. 5. Complications of transmural alone vs. combined drainage of pancreatic fluid collections (PFCs). OR, odds ratio; CI, confidence interval; CD, combination of both drainage method; TM, transmural drainage.

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