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Bhurwal A , Tawadros A , Mutneja H , Gjeorgjievski M , Shah I , Bansal V , Patel A , Sarkar A , Bartel M , Brahmbhatt B
EUS guided pancreatic duct decompression in surgically altered anatomy or failed ERCP - A systematic review, meta-analysis and meta-regression
Pancreatology. 2021 Aug;21(5) :990-1000
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INTRODUCTION: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.
1424-3911 Bhurwal, Abhishek Tawadros, Augustine Mutneja, Hemant Gjeorgjievski, Mihajlo Shah, Ishani Bansal, Vikas Patel, Anish Sarkar, Avik Bartel, Michal Brahmbhatt, Bhaumik Journal Article Switzerland Pancreatology. 2021 Apr 10:S1424-3903(21)00136-8. doi: 10.1016/j.pan.2021.03.021.