Systematic review comparing endoscopic, percutaneous and surgical pancreatic pseudocyst drainage

• 作者: Anthony Yuen Bun Teoh Dong Wan Seo Khek Yu Ho Mitsuhiro Kida Vinay Dhir Zhen-Dong Jin
• 来源期刊: 世界胃肠内镜杂志：英文版（电子版）
• 学科: 医学
• 关键词: INTERVENTIONAL ENDOSONOGRAPHY ENDOSCOPIC ultrasound PANCREATIC PSEUDOCYST Cystogastrostomy Cystojejunostomy PSEUDOCYST drainage
• 年，卷（期）: 2016,（6）
• 页码范围: 310-318
• 页数: 9页
• 分类号: R

摘要

AIM: To perform a systematic review comparing the outcomes of endoscopic, percutaneous and surgical pancreatic pseudocyst drainage.METHODS: Comparative studies published between January 1980 and May 2014 were identified on PubMed,Embase and the Cochrane controlled trials register and assessed for suitability of inclusion. The primary outcome was the treatment success rate. Secondary outcomes included were the recurrence rates, re-interventions,length of hospital stay, adverse events and mortalities.RESULTS: Ten comparative studies were identified and 3 were randomized controlled trials. Four studies reported on the outcomes of percutaneous and surgical drainage. Based on a large-scale national study, surgical drainage appeared to reduce mortality and adverse events rate as compared to the percutaneous approach.Three studies reported on the outcomes of endoscopic ultrasound (EUS) and surgical drainage. Clinical success and adverse events rates appeared to be comparable but the EUS approach reduced hospital stay, cost and improved quality of life. Three other studies compared EUS and esophagogastroduodenoscopy-guided drainage.Both approaches were feasible for pseudocyst drainage but the success rate of the EUS approach was better for non-bulging cyst and the approach conferred additional safety benefits.CONCLUSION: EUS-guided drainage appeared to be advantageous in drainage of pancreatic pseudocysts located adjacent to the stomach or duodenum. In patients with unfavorable anatomy, surgical cystojejunostomy or percutaneous drainage could be considered.Large randomized studies with current definitions of pseudocysts and longer-term follow-up are needed to assess the efficacy of the various modalities.