Systematic Reviews
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jul 16, 2022; 14(7): 443-454
Published online Jul 16, 2022. doi: 10.4253/wjge.v14.i7.443
Quality of life after surgical and endoscopic management of severe acute pancreatitis: A systematic review
Emmanouil Psaltis, Chris Varghese, Sanjay Pandanaboyana, Manu Nayar
Emmanouil Psaltis, Sanjay Pandanaboyana, Department of HPB and Transplant Surgery, Newcastle upon Tyne NE7 7DN, United Kingdom
Emmanouil Psaltis, Sanjay Pandanaboyana, Department of Surgery, Freeman Hospital, Newcastle upon Tyne NE7 7DN, United Kingdom
Chris Varghese, Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1010, New Zealand
Sanjay Pandanaboyana, Manu Nayar, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, United Kingdom
Manu Nayar, Department of Gastroenterology, Freeman Hospital, Newcastle upon Tyne NE7 7DN, United Kingdom
Author contributions: Psaltis E, Varghese C, Pandanaboyana S and Nayar M designed the research study; Psaltis E and Varghese C performed the research; Psaltis E and Varghese C analyzed the data and wrote the manuscript; Pandanaboyana S and Nayar M had the overall supervision of the study; all authors have read and approved the final manuscript.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Manu Nayar, MBBS, MD, MRCP, Consultant Physician-Scientist, Doctor, Department of Gastroenterology, Freeman Hospital, Freeman Road, High Heaton, Newcastle Upon Tyne NE7 7DN, United Kingdom. manu.nayar@nhs.net
Received: January 27, 2022
Peer-review started: January 27, 2022
First decision: April 10, 2022
Revised: May 3, 2022
Accepted: June 20, 2022
Article in press: June 20, 2022
Published online: July 16, 2022
Abstract
BACKGROUND

Treatment for severe acute severe pancreatitis (SAP) can significantly affect Health-related quality of life (HR-QoL). The effects of different treatment strategies such as endoscopic and surgical necrosectomy on HR-QoL in patients with SAP remain poorly investigated.

AIM

To critically appraise the available evidence on HR-QoL following surgical or endoscopic necrosectomy in patient with SAP.

METHODS

A literature search was performed on PubMed, Google™ Scholar, the Cochrane Library, MEDLINE and Reference Citation Analysis databases for studies that investigated HR-QoL following surgical or endoscopic necrosectomy in patients with SAP. Data collected included patient characteristics, outcomes of interventions and HR-QoL-related details.

RESULTS

Eleven studies were found to have evaluated HR-QoL following treatment for severe acute pancreatitis including 756 patients. Three studies were randomized trials, four were prospective cohort studies and four were retrospective cohort studies with prospective follow-up. Four studies compared HR-QoL following surgical and endoscopic necrosectomy. Several metrics of HR-QoL were used including Short Form (SF)-36 and EuroQol. One randomized trial and one cohort study demonstrated significantly improved physical scores at three months in patients who underwent endoscopic necrosectomy compared to surgical necrosectomy. One prospective study that examined HR-QoL following surgical necrosectomy reported some deterioration in the functional status of the patients. On the other hand, a cohort study that assessed the long-term HR-QoL following sequential surgical necrosectomy stated that all patients had SF-36 > 60%. In the only study that examined patients following endoscopic necrosectomy, the HR-QoL was also very good. Three studies investigated the quality adjusted life years suggesting that endoscopic and surgical approaches to management of pancreatic necrosis were comparable in cost effectiveness. Finally, regarding HR-QoL between open necrosectomy and minimally invasive approaches, patients who underwent the later had a significantly better overall quality of life, vitality and mental health.

CONCLUSION

This review would suggest that the endoscopic approach might offer better HR-QoL compared to surgical necrosectomy. However, the available comparative literature was very limited. More randomized trials powered to detect differences in HR-QoL are required.

Keywords: Acute pancreatitis, Pancreatic necrosis, Surgical necrosectomy, Endoscopic necrosectomy, Minimally invasive drainage, Quality of life

Core Tip: Acute pancreatitis is a common disease with potentially life-threatening complications. Treatment for severe acute pancreatitis can significantly affect health-related quality of life (HR-QoL). The effects of different treatment strategies such as endoscopic and surgical necrosectomy on HR-QoL remain poorly investigated. In this review, we critically analyze the available evidence on HR-QoL following treatment for severe acute pancreatitis. It could be suggested that endoscopic necrosectomy could offer better HR-QoL compared to surgical necrosectomy.