内镜超声引导下射频消融治疗胰腺病变的疗效与安全性：一项系统评价和Meta分析
Efficacy and safety of endoscopic ultrasound-guided radiofrequency ablation for management of pancreatic lesions: a systematic review and meta-analysis.
作者信息
Fahmawi Yazan, Mehta Ansh, Abdalhadi Haneen, Merritt Lindsey, Mizrahi Meir
机构信息
Department of Internal Medicine, University of South Alabama, Mobile, AL, USA.
Department of Gastroenterology and Hepatology, Advanced Endoscopy Unit, University of South Alabama, Mobile, AL, USA.
出版信息
Transl Gastroenterol Hepatol. 2022 Jul 25;7:30. doi: 10.21037/tgh-20-84. eCollection 2022.
BACKGROUND
Radiofrequency ablation (RFA) has been used to treat various abdominal tumors including pancreatic tumors. Multiple approaches such as laparoscopic, open, and percutaneous have been used for pancreatic tissue ablation. More recently, endoscopic ultrasound (EUS)-guided RFA has emerged as a new technique for pancreatic tissue ablation. The role of EUS-RFA in management of pancreatic lesions is still not well-established. In this study, our aim is to assess efficacy and safety of EUS-RFA for management of pancreatic lesions.
METHODS
MEDLINE, Scopus, and Cochrane Library databases were searched to identify studies reporting EUS-RFA of pancreatic lesions with outcomes of interest. Studies with <5 patients were excluded. Clinical success was defined as symptom resolution, decrease in tumor size, and/or evidence of necrosis on radiologic imaging. Efficacy was assessed by the pooled clinical response rate whereas safety was assessed by the pooled adverse events rate. Heterogeneity was assessed using I. Pooled estimates and the 95% CI were calculated using random-effect model.
RESULTS
Ten studies (5 retrospective and 5 prospective) involving 115 patients with 125 pancreatic lesions were included. 152 EUS-RFA procedures were performed. The lesions comprised of 37.6% non-functional neuroendocrine tumors (NFNETs), 15.4% were insulinomas, 26.5% were pancreatic cystic neoplasms (PCNs), and 19.7% were pancreatic adenocarcinomas. The majority were present in the pancreatic head (40.2%), 38.3% in the body, 11.2% in the tail, and 10.3% in the uncinate process. Pooled overall clinical response rate was 88.9% (95% CI: 82.4-93.7, I=38.1%). Pooled overall adverse events rate was 6.7% (95% CI: 3.4-11.7, I=34.0%). The most common complication was acute pancreatitis (3.3%) followed by pancreatic duct stenosis, peripancreatic fluid collection, and ascites (2.8%) each. Only one case of perforation was reported with pooled rate of (2.1%).
DISCUSSION
This study demonstrates that EUS-RFA is an effective treatment modality for pancreatic lesions, especially functional neuroendocrine tumors such as insulinomas.
背景
射频消融（RFA）已被用于治疗包括胰腺肿瘤在内的各种腹部肿瘤。腹腔镜、开放和经皮等多种方法已用于胰腺组织消融。最近，内镜超声（EUS）引导下的RFA已成为一种新的胰腺组织消融技术。EUS-RFA在胰腺病变管理中的作用仍未完全确立。在本研究中，我们的目的是评估EUS-RFA治疗胰腺病变的疗效和安全性。
方法
检索MEDLINE、Scopus和Cochrane图书馆数据库，以确定报告胰腺病变EUS-RFA及相关感兴趣结果的研究。排除患者少于5例的研究。临床成功定义为症状缓解、肿瘤大小减小和/或影像学上有坏死证据。疗效通过合并临床反应率评估，而安全性通过合并不良事件率评估。使用I²评估异质性。采用随机效应模型计算合并估计值和95%置信区间。
结果
纳入10项研究（5项回顾性研究和5项前瞻性研究），涉及115例患者的125个胰腺病变。共进行了152次EUS-RFA手术。病变包括37.6%的无功能神经内分泌肿瘤（NFNETs）、15.4%的胰岛素瘤、26.5%的胰腺囊性肿瘤（PCNs）和19.7%的胰腺腺癌。大多数病变位于胰头（40.2%），胰体占38.3%，胰尾占11.2%，钩突占10.3%。合并总体临床反应率为88.9%（95%置信区间：82.4-93.7，I²=38.1%）。合并总体不良事件率为6.7%（95%置信区间：3.4-11.7，I²=34.0%）。最常见的并发症是急性胰腺炎（3.3%），其次是胰管狭窄、胰周积液和腹水（各2.8%）。仅报告1例穿孔，合并发生率为（2.1%）。
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