EUS guided pancreatic duct decompression in surgically altered anatomy or failed ERCP – A systematic review, meta-analysis and meta-regression

Abstract

IntroductionEUS-PD (EUS guided pancreatic duct drainage) is classified into two types: EUS-guided rendezvous techniques and EUS-guided PD stenting. Prior studies showed significant variation in terms of technical success, clinical success and adverse events. MethodsThree independent reviewers performed a comprehensive review of all original articles published from inception to June 2020, describing pancreatic duct drainage utilizing EUS. Primary outcomes were technical success, clinical success of EUS-PDD and safety of EUS-PD in terms of adverse events. All meta-analysis and meta-regression tests were 2-tailed. Finally, probability of publication bias was assessed using funnel plots and with Egger’s test. ResultsA total of sixteen studies (503 patients) described the use of EUS-PD for pancreatic duct decompression yielded a pooled technical success rate was 81.4% (95% CI 72–88.1, I 2 = 74). Meta-regression revealed that proportion of altered anatomy and method of dilation of tract explain the variance. Overall pooled clinical success rate was 84.6% (95% CI 75.4–90.8, I 2 = 50.18). Meta-regression analysis revealed that the type of pancreatic duct decompression, proportion of altered anatomy and follow up time explained the variance. Overall pooled adverse event rate was 21.3% (95% CI 16.8–26.7, I 2 = 36.6). The most common post procedure adverse event was post procedure pain. Overall pooled adverse event rate of post EUS-PD pancreatitis was 5% (95% CI 3.2–7.8, I 2 = 0). ConclusionThe systematic review, meta-analysis and meta-regression provides answer to the questions of the overall technical success, clinical success and the adverse event rate of EUS-PD by summarizing the available literature.