Success of endoscopic ultrasound-guided ethanol ablation of pancreatic cysts: a meta-analysis and systematic review.

Abstract

BACKGROUND:

Endoscopic ultrasound (EUS)-guided ethanol ablation has emerged as an efficacious and safe alternative management option for pancreatic cysts. We undertook a meta-analysis and systematic review to assess the overall safety and efficacy of EUS-guided ethanol ablation of pancreatic cysts.

METHOD STUDY SELECTION CRITERIA:

EUS-guided ethanol ablation of pancreatic cysts.

DATA COLLECTION EXTRACTION:

Articles were searched in Medline, Pubmed, and Ovid journals.

STATISTICAL METHOD:

Fixed and random effects models were used to calculate the pooled proportions.

RESULTS:

Initial search identified 1,319 reference articles, in which 120 relevant articles were selected and reviewed. Data was extracted from seven studies (n = 152) of EUS-guided ethanol ablation of pancreatic cysts, which met the inclusion criteria. With EUS-guided ethanol ablation, the pooled proportion of patients with complete cyst resolution was 56.20 % (95 % CI = 48.16 to 64.08) and partial cyst resolution was 23.72 % (95 % CI = 17.24 to 30.89). Postprocedural complications after ablation were significant for abdominal pain in 6.51 % (95 % CI = 3.12 to 11.04) and pancreatitis in 3.90 % (95 % CI = 1.39 to 7.60) of the pooled percentage of patients. Publication bias calculated using Harbord-Egger bias indicator gave a value of -1.09 (95 % CI = 10.21 to 8.03, p = 0.77). The Begg-Mazumdar indicator gave a Kendall's tau b value of 0.05 (p ≥ 0.99).

CONCLUSIONS:

EUS-guided ethanol ablation may be a safe alternative treatment modality for pancreatic cysts, with acceptable intraprocedural and postprocedural complications. However, due to the limited data available, prospective randomized controlled trials with a long follow up period are required in this area.

• Authors: Manasa Kandula, Harsha Moole, Michael Cashman, Fritz H Volmar, Matthew L Bechtold, Srinivas R Puli
• Journal: Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology (Indian J Gastroenterol) Vol. 34 Issue 3 Pg. 193-9 (May 2015) ISSN: 0975-0711 [Electronic] India
• PMID: 26108653 (Publication Type: Journal Article, Meta-Analysis, Systematic Review)

Chemical References

• Ethanol

Topics

• Ablation Techniques (methods)
• Databases, Bibliographic
• Endosonography (methods)
• Ethanol (therapeutic use)
• Humans
• Pancreatic Cyst (surgery)
• Surgery, Computer-Assisted (methods)