Endoscopic versus surgical treatment for infected necrotizing pancreatitis: a systematic review and meta-analysis of randomized controlled trials.
Acute pancreatitis
Endoscopy
Necrosectomy
Randomized controlled trials
Systematic review
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
06 2020
06 2020
Historique:
received:
06
11
2019
accepted:
19
02
2020
pubmed:
1
3
2020
medline:
28
5
2021
entrez:
1
3
2020
Statut:
ppublish
Résumé
To compare outcomes of endoscopic and surgical treatment for infected necrotizing pancreatitis (INP) based on results of randomized controlled trials (RCT). Treatment of INP has changed in the last two decades with adoption of interventional, endoscopic and minimally invasive surgical procedures for drainage and necrosectomy. However, this relies mostly on observational studies. We performed a systematic review following Cochrane and PRISMA guidelines and AMSTAR-2 criteria and searched CENTRAL, Medline and Web of Science. Randomized controlled trails that compared an endoscopic treatment to a surgical treatment for patients with infected walled-off necrosis and included one of the main outcomes were eligible for inclusion. The main outcomes were mortality and new onset multiple organ failure. Prospero registration ID: CRD42019126033 RESULTS: Three RCTs with 190 patients were included. Intention to treat analysis showed no difference in mortality. However, patients in the endoscopic group had statistically significant lower odds of experiencing new onset multiple organ failure (odds ratio (OR) confidence interval [CI] 0.31 [0.10, 0.98]) and were statistically less likely to suffer from perforations of visceral organs or enterocutaneous fistulae (OR [CI] 0.31 [0.10, 0.93]), and pancreatic fistulae (OR [CI] 0.09 [0.03, 0.28]). Patients with endoscopic treatment had a statistically significant lower mean hospital stay (Mean difference [CI] - 7.86 days [- 14.49, - 1.22]). No differences in bleeding requiring intervention, incisional hernia, exocrine or endocrine insufficiency or ICU stay were apparent. Overall certainty of evidence was moderate. There seem to be possible benefits of endoscopic treatment procedure. Given the heterogenous procedures in the surgical group as well as the low amount of randomized evidence, further studies are needed to evaluate the combination of different approaches and appropriate timepoints for interventions.
Sections du résumé
OBJECTIVE
To compare outcomes of endoscopic and surgical treatment for infected necrotizing pancreatitis (INP) based on results of randomized controlled trials (RCT).
BACKGROUND
Treatment of INP has changed in the last two decades with adoption of interventional, endoscopic and minimally invasive surgical procedures for drainage and necrosectomy. However, this relies mostly on observational studies.
METHODS
We performed a systematic review following Cochrane and PRISMA guidelines and AMSTAR-2 criteria and searched CENTRAL, Medline and Web of Science. Randomized controlled trails that compared an endoscopic treatment to a surgical treatment for patients with infected walled-off necrosis and included one of the main outcomes were eligible for inclusion. The main outcomes were mortality and new onset multiple organ failure. Prospero registration ID: CRD42019126033 RESULTS: Three RCTs with 190 patients were included. Intention to treat analysis showed no difference in mortality. However, patients in the endoscopic group had statistically significant lower odds of experiencing new onset multiple organ failure (odds ratio (OR) confidence interval [CI] 0.31 [0.10, 0.98]) and were statistically less likely to suffer from perforations of visceral organs or enterocutaneous fistulae (OR [CI] 0.31 [0.10, 0.93]), and pancreatic fistulae (OR [CI] 0.09 [0.03, 0.28]). Patients with endoscopic treatment had a statistically significant lower mean hospital stay (Mean difference [CI] - 7.86 days [- 14.49, - 1.22]). No differences in bleeding requiring intervention, incisional hernia, exocrine or endocrine insufficiency or ICU stay were apparent. Overall certainty of evidence was moderate.
CONCLUSION
There seem to be possible benefits of endoscopic treatment procedure. Given the heterogenous procedures in the surgical group as well as the low amount of randomized evidence, further studies are needed to evaluate the combination of different approaches and appropriate timepoints for interventions.
Identifiants
pubmed: 32112252
doi: 10.1007/s00464-020-07469-9
pii: 10.1007/s00464-020-07469-9
pmc: PMC7214487
doi:
Types de publication
Comparative Study
Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
2429-2444Références
J Am Coll Surg. 2014 Oct;219(4):735-43
pubmed: 25158913
Minerva Chir. 2016 Aug;71(4):262-9
pubmed: 27152629
Ann Surg. 2006 Feb;243(2):154-68
pubmed: 16432347
Trials. 2019 Apr 25;20(1):239
pubmed: 31023380
Langenbecks Arch Surg. 2019 May;404(3):273-284
pubmed: 30824993
BMC Gastroenterol. 2013 Nov 25;13:161
pubmed: 24274589
Langenbecks Arch Surg. 2018 Feb;403(1):119-129
pubmed: 29209758
Gut. 2018 Apr;67(4):697-706
pubmed: 28774886
Gastroenterology. 2010 Sep;139(3):813-20
pubmed: 20540942
Nat Rev Gastroenterol Hepatol. 2014 Aug;11(8):462-9
pubmed: 24662281
J Clin Epidemiol. 2009 Oct;62(10):1006-12
pubmed: 19631508
JAMA. 2012 Mar 14;307(10):1053-61
pubmed: 22416101
Ann Surg. 2016 Jul;264(1):87-92
pubmed: 26465782
Gastroenterology. 2019 Mar;156(4):1027-1040.e3
pubmed: 30452918
BMC Med Res Methodol. 2005 Apr 20;5:13
pubmed: 15840177
Lancet. 2018 Jan 6;391(10115):51-58
pubmed: 29108721
Can J Gastroenterol Hepatol. 2014 Jan;28(1):50-3
pubmed: 24212912
BMJ. 2017 Sep 21;358:j4008
pubmed: 28935701
Br J Surg. 2014 Dec;101(13):1729-38
pubmed: 25333872
Gastroenterology. 2019 Mar;156(4):1016-1026
pubmed: 30391468
Cochrane Database Syst Rev. 2016 Apr 16;4:CD011383
pubmed: 27083933
N Engl J Med. 2016 Nov 17;375(20):1972-1981
pubmed: 27959604
Gastroenterology. 2013 Feb;144(2):333-340.e2
pubmed: 23063972
Ned Tijdschr Geneeskd. 2012;156(4):A4329
pubmed: 22278038
Ann Surg. 2000 Nov;232(5):619-26
pubmed: 11066131
N Engl J Med. 2010 Apr 22;362(16):1491-502
pubmed: 20410514
Surg Endosc. 2020 Mar;34(3):1157-1166
pubmed: 31140002
Gut. 2019 Jul;68(7):1200-1209
pubmed: 29858393
Gut. 2009 Sep;58(9):1260-6
pubmed: 19282306
Br J Surg. 2011 Jan;98(1):18-27
pubmed: 21136562
Pancreas. 2012 Mar;41(2):271-7
pubmed: 21956639
Gastroenterology. 2019 Aug;157(2):583-584
pubmed: 31103626
Dig Endosc. 2016 Jan;28(1):103
pubmed: 26456692