Performance and Safety of EUS Ablation Techniques for Pancreatic Cystic Lesions: A Systematic Review and Meta-Analysis.
EUS
RFA
ablation
ethanol
lauromacrogol
paclitaxel
pancreatic cyst
Journal
Cancers
ISSN: 2072-6694
Titre abrégé: Cancers (Basel)
Pays: Switzerland
ID NLM: 101526829
Informations de publication
Date de publication:
05 May 2023
05 May 2023
Historique:
received:
07
04
2023
revised:
29
04
2023
accepted:
01
05
2023
medline:
13
5
2023
pubmed:
13
5
2023
entrez:
13
5
2023
Statut:
epublish
Résumé
Pancreatic cystic lesions (PCL) represent an increasingly diagnosed condition with significant burden to patients' lives and medical resources. Endoscopic ultrasound (EUS) ablation techniques have been utilized to treat focal pancreatic lesions. This systematic review with meta-analysis aims to assess the efficacy of EUS ablation on PCL in terms of complete or partial response and safety. A systematic search in Medline, Cochrane and Scopus databases was performed in April 2023 for studies assessing the performance of the various EUS ablation techniques. The primary outcome was complete cyst resolution, defined as cyst disappearance in follow-up imaging. Secondary outcomes included partial resolution (reduction in PCL size), and adverse events rate. A subgroup analysis was planned to evaluate the impact of the available ablation techniques (ethanol, ethanol/paclitaxel, radiofrequency ablation (RFA), and lauromacrogol) on the results. Meta-analyses using a random effects model were conducted and the results were reported as percentages with 95% confidence intervals (95%CI). Fifteen studies (840 patients) were eligible for analysis. Complete cyst resolution after EUS ablation was achieved in 44% of cases (95%CI: 31-57; 352/767; I EUS ablation of pancreatic cysts provides acceptable rates of complete resolution and a low incidence of severe adverse events, with chemoablative agents yielding higher performance rates.
Sections du résumé
BACKGROUND
BACKGROUND
Pancreatic cystic lesions (PCL) represent an increasingly diagnosed condition with significant burden to patients' lives and medical resources. Endoscopic ultrasound (EUS) ablation techniques have been utilized to treat focal pancreatic lesions. This systematic review with meta-analysis aims to assess the efficacy of EUS ablation on PCL in terms of complete or partial response and safety.
METHODS
METHODS
A systematic search in Medline, Cochrane and Scopus databases was performed in April 2023 for studies assessing the performance of the various EUS ablation techniques. The primary outcome was complete cyst resolution, defined as cyst disappearance in follow-up imaging. Secondary outcomes included partial resolution (reduction in PCL size), and adverse events rate. A subgroup analysis was planned to evaluate the impact of the available ablation techniques (ethanol, ethanol/paclitaxel, radiofrequency ablation (RFA), and lauromacrogol) on the results. Meta-analyses using a random effects model were conducted and the results were reported as percentages with 95% confidence intervals (95%CI).
RESULTS
RESULTS
Fifteen studies (840 patients) were eligible for analysis. Complete cyst resolution after EUS ablation was achieved in 44% of cases (95%CI: 31-57; 352/767; I
CONCLUSION
CONCLUSIONS
EUS ablation of pancreatic cysts provides acceptable rates of complete resolution and a low incidence of severe adverse events, with chemoablative agents yielding higher performance rates.
Identifiants
pubmed: 37174092
pii: cancers15092627
doi: 10.3390/cancers15092627
pmc: PMC10177078
pii:
doi:
Types de publication
Journal Article
Review
Langues
eng
Références
Gastroenterology. 2021 Jun;160(7):2234-2238
pubmed: 33609506
AMRC Open Res. 2020 Jan 16;1:4
pubmed: 32322783
Gastroenterology. 2015 Apr;148(4):819-22; quize12-3
pubmed: 25805375
Endoscopy. 2017 Oct;49(10):989-1006
pubmed: 28898917
Abdom Radiol (NY). 2021 Aug;46(8):3946-3962
pubmed: 33742217
Diagnostics (Basel). 2023 Feb 02;13(3):
pubmed: 36766654
Nat Rev Gastroenterol Hepatol. 2019 Nov;16(11):676-689
pubmed: 31527862
Clin Gastroenterol Hepatol. 2023 Mar 4;:
pubmed: 36871765
Endoscopy. 2021 Jul;53(7):739-743
pubmed: 33063298
Pancreatology. 2020 Apr;20(3):505-510
pubmed: 31948794
Gastroenterology. 2011 Jan;140(1):172-9
pubmed: 20950614
VideoGIE. 2018 Apr 12;3(5):159-161
pubmed: 29916497
Scand J Gastroenterol. 2020 Sep;55(9):1121-1131
pubmed: 32730715
BMJ. 2003 Sep 6;327(7414):557-60
pubmed: 12958120
Control Clin Trials. 1986 Sep;7(3):177-88
pubmed: 3802833
Gastrointest Endosc. 2017 Nov;86(5):872-880
pubmed: 28365355
Gastroenterology. 2017 Nov;153(5):1295-1303
pubmed: 28802565
Pancreatology. 2017 Sep - Oct;17(5):738-753
pubmed: 28735806
Pathobiology. 2022;89(1):49-55
pubmed: 34515187
Turk J Gastroenterol. 2018 Jan;29(1):101-104
pubmed: 29082889
Gastrointest Endosc. 2017 Jun;85(6):1233-1242
pubmed: 27650271
Pancreas. 2014 Jul;43(5):755-61
pubmed: 24743379
Hepatobiliary Pancreat Dis Int. 2019 Dec;18(6):562-568
pubmed: 31551143
BMJ. 2021 Mar 29;372:n71
pubmed: 33782057
Endoscopy. 2017 Sep;49(9):866-873
pubmed: 28511236
Clin Endosc. 2015 Mar;48(2):158-64
pubmed: 25844345
Endosc Ultrasound. 2012 Apr;1(1):48-52
pubmed: 24949335
Gut. 2018 May;67(5):789-804
pubmed: 29574408
Medicina (Kaunas). 2023 Feb 14;59(2):
pubmed: 36837560
Gastroenterology. 2013 Jun;144(6):1303-15
pubmed: 23622140
Diagn Interv Radiol. 2023 Feb 13;29(2):342-349
pubmed: 36987999
Gastrointest Endosc. 2009 Oct;70(4):710-23
pubmed: 19577745
AMIA Annu Symp Proc. 2006;:359-63
pubmed: 17238363
Surgery. 2020 Oct;168(4):601-609
pubmed: 32739138
Gastrointest Endosc. 2005 May;61(6):746-52
pubmed: 15855986
J Surg Res. 2020 Mar;247:547-555
pubmed: 31740011
Endosc Ultrasound. 2022 May-Jun;11(3):170-185
pubmed: 35313416
Gastrointest Endosc. 2023 Apr;97(4):741-751.e1
pubmed: 36400239
Endosc Int Open. 2019 Sep;7(9):E1064-E1077
pubmed: 31475223
Therap Adv Gastroenterol. 2018 Mar 07;11:1756284818759929
pubmed: 29535793
Am J Gastroenterol. 2020 Oct;115(10):1689-1697
pubmed: 32558682
Gastrointest Endosc. 2016 May;83(5):914-20
pubmed: 26363331
GE Port J Gastroenterol. 2020 Nov;27(6):410-416
pubmed: 33251290
Eur J Gastroenterol Hepatol. 2022 Nov 1;34(11):1111-1115
pubmed: 36170679
Endosc Ultrasound. 2022 Jan-Feb;11(1):44-52
pubmed: 33473042
Pancreas. 2011 Jul;40(5):664-8
pubmed: 21562447
J Clin Epidemiol. 2011 Dec;64(12):1303-10
pubmed: 21802903
Endoscopy. 2019 Sep;51(9):836-842
pubmed: 30669161