S99 Hydrogen Peroxide-Assisted Endoscopic Necrosectomy for Walled-Off Pancreatic Necrosis: A Systematic Review and Meta-Analysis

Abstract

Introduction: Endoscopic necrosectomy (EN) is the preferred approach for drainage of walled-off pancreatic necrosis (WOPN) commonly performed with the aid of endoscopic ultrasound (EUS) guided. Hydrogen peroxide (H2O2) has been reported to be a good adjunctive therapy for Direct Endoscopic Necrosectomy (DEN). We performed a systematic review and meta-analysis to evaluate effectiveness and safety of H2O2 assisted EN for WOPN. Methods: A comprehensive search of multiple databases (through December 2020) was performed to identify studies that reported outcomes of H2O2 assisted EN for WOPN. Outcomes assessed included clinical success, technical success, and adverse events. Results: A total of 454 patients with mean age (47.3 ± 7.9 years) and WOPN size (12.4 ± 3.1 cm) were included from 15 studies. The mean number of procedures performed were 3.0 ± 0.9 and majority of patients underwent trans-gastric approach (n=288). The rates of technical success, clinical success and adverse events was 97.3 (95% confidence interval [CI]: 94.8 – 98.6, I2 =0), 89.8% (95% CI: 86.3 – 92.5, I2 =0) and 17.9% (95% CI: 12.6 – 24.7, I2 =38), respectively. The most common adverse event was bleeding with rate of 7.1% followed by stent migration (5.3%). On meta-regression, lesion size, patient age, metal stent, number of necrosectomies and transgastric access was not significant predictor for technical success, clinical success, adverse events or bleeding. Conclusion: To the best of our knowledge, this is the first systemic review and meta-analysis to evaluate effectiveness and safety of H2O2 assisted EN for WOPN. EUS-guided drainage followed by necrosectomy of WOPN has become preferred procedure either independently or as a part of step-up approach. H2O2 assisted EN is highly effective and safe for drainage of WOPN. Its use should be encouraged, and future randomized controlled studies are needed to study the predictors of success.Figure 1.: PRISMA Flow diagram showing search strategy for meta-analysis.