Systematic Reviews
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Mar 25, 2016; 8(6): 310-318
Published online Mar 25, 2016. doi: 10.4253/wjge.v8.i6.310
Systematic review comparing endoscopic, percutaneous and surgical pancreatic pseudocyst drainage
Anthony Yuen Bun Teoh, Vinay Dhir, Zhen-Dong Jin, Mitsuhiro Kida, Dong Wan Seo, Khek Yu Ho
Anthony Yuen Bun Teoh, Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China
Vinay Dhir, Baldota Institute of Digestive Sciences, Maharashtra 400012, Mumbai, India
Zhen-Dong Jin, Department of Gastroenterology, Changhai Hospital, Shanghai 200433, China
Mitsuhiro Kida, Department of Gastroenterology, Kitasato University East Hospital, Kitasato 252-0380, Japan
Dong Wan Seo, Department of Gastroenterology, Asan Medical Centre, Seoul 138-050, South Korea
Khek Yu Ho, Department of Medicine, National University of Singapore, Singapore 119077, Singapore
Author contributions: Teoh AYB design, literature review, quality assessment, and writing up of the manuscript; Dhir V design, literature review and quality assessment; Jin ZD and Kida M important intellectual input, final approval of the article; Seo DW designed, important intellectual input and final approval of the article; Ho KY concept, important intellectual input, final approval of the article.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at anthonyteoh@surgery.cuhk.edu.hk. Consent was not obtained but the presented data are anonymized and risk of identification is low.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Anthony Yuen Bun Teoh, Professor, Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China. anthonyteoh@surgery.cuhk.edu.hk
Telephone: +852-26322627 Fax: +852-26377974
Received: November 24, 2015
Peer-review started: November 25, 2015
First decision: December 22, 2015
Revised: January 2, 2016
Accepted: January 29, 2016
Article in press: January 31, 2016
Published online: March 25, 2016
Abstract

AIM: To perform a systematic review comparing the outcomes of endoscopic, percutaneous and surgical pancreatic pseudocyst drainage.

METHODS: Comparative studies published between January 1980 and May 2014 were identified on PubMed, Embase and the Cochrane controlled trials register and assessed for suitability of inclusion. The primary outcome was the treatment success rate. Secondary outcomes included were the recurrence rates, re-interventions, length of hospital stay, adverse events and mortalities.

RESULTS: Ten comparative studies were identified and 3 were randomized controlled trials. Four studies reported on the outcomes of percutaneous and surgical drainage. Based on a large-scale national study, surgical drainage appeared to reduce mortality and adverse events rate as compared to the percutaneous approach. Three studies reported on the outcomes of endoscopic ultrasound (EUS) and surgical drainage. Clinical success and adverse events rates appeared to be comparable but the EUS approach reduced hospital stay, cost and improved quality of life. Three other studies compared EUS and esophagogastroduodenoscopy-guided drainage. Both approaches were feasible for pseudocyst drainage but the success rate of the EUS approach was better for non-bulging cyst and the approach conferred additional safety benefits.

CONCLUSION: EUS-guided drainage appeared to be advantageous in drainage of pancreatic pseudocysts located adjacent to the stomach or duodenum. In patients with unfavorable anatomy, surgical cystojejunostomy or percutaneous drainage could be considered. Large randomized studies with current definitions of pseudocysts and longer-term follow-up are needed to assess the efficacy of the various modalities.

Keywords: Interventional endosonography, Endoscopic ultrasound, Pancreatic pseudocyst, Cystogastrostomy, Cystojejunostomy, Pseudocyst drainage

Core tip: Pancreatic pseudocysts are traditionally managed by open surgical internal drainage. With continued improvements in medical technology, the uses of percutaneous, endoscopic and laparoscopic drainage were increasingly reported. Nevertheless, trials comparing these different approaches are lacking. In this systematic review, endoscopic ultrasound-guided drainage appeared to be advantageous in drainage of pancreatic pseudocysts located adjacent to the stomach or duodenum. In patients with unfavorable anatomy, surgical cystojejunostomy or percutaneous drainage could be considered. Large randomized studies with current definitions of pseudocysts and longer-term follow-up are needed to assess the efficacy of the various modalities.