Bhurwal Abhishek, Tawadros Augustine, Mutneja Hemant, Gjeorgjievski Mihajlo, Shah Ishani, Bansal Vikas, Patel Anish, Sarkar Avik, Bartel Michal, Brahmbhatt Bhaumik
Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ, United States.
Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ, United States.
Pancreatology. 2021 Aug;21(5):990-1000. doi: 10.1016/j.pan.2021.03.021. Epub 2021 Apr 10.
EUS-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.
Three 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.
A 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).
The 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.
超声内镜引导下胰管引流术（EUS-PD）分为两种类型：超声内镜引导下会师技术和超声内镜引导下胰管支架置入术。先前的研究表明，在技术成功率、临床成功率和不良事件方面存在显著差异。
三位独立的评审员对从开始到2020年6月发表的所有描述使用超声内镜进行胰管引流的原始文章进行了全面综述。主要结局包括技术成功率、EUS-PDD的临床成功率以及超声内镜引导下胰管引流术在不良事件方面的安全性。所有荟萃分析和荟萃回归检验均为双侧检验。最后，使用漏斗图和Egger检验评估发表偏倚的可能性。
共有16项研究（503例患者）描述了使用超声内镜引导下胰管引流术进行胰管减压，汇总技术成功率为81.4%（95%CI 72-88.1，I² = 74）。荟萃回归显示，解剖结构改变的比例和通道扩张方法可解释其中的差异。总体汇总临床成功率为84.6%（95%CI 75.4-90.8，I² = 50.18）。荟萃回归分析显示，胰管减压类型、解剖结构改变的比例和随访时间可解释其中的差异。总体汇总不良事件发生率为21.3%（95%CI 16.8-26.7，I² = 36.6）。最常见的术后不良事件是术后疼痛。超声内镜引导下胰管引流术后胰腺炎的总体汇总不良事件发生率为5%（95%CI 3.2-7.8，I² = 0）。
该系统评价、荟萃分析和荟萃回归通过总结现有文献，回答了超声内镜引导下胰管引流术的总体技术成功率、临床成功率和不良事件发生率的问题。
