Download PDF
CC BY-NC-ND 4.0 · Endosc Int Open 2022; 10(04): E420-E428
DOI: 10.1055/a-1783-9229
Review

Endoscopic or surgical treatment for necrotizing pancreatitis: Comprehensive systematic review and meta-analysis

Mehdi Mohamadnejad
1   Liver and Pancreaticobiliary Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
,
Amir Anushiravani
1   Liver and Pancreaticobiliary Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
,
Amir Kasaeian
1   Liver and Pancreaticobiliary Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
2   Hematology, Oncology and Stem Cell Transplantation Research Center, Research Institute for Oncology, Hematology and Cell Therapy, Tehran University of Medical Sciences, Tehran, Iran
3   Inflammation Research Center, Tehran University of Medical Sciences, Tehran, Iran.
,
Majid Sorouri
1   Liver and Pancreaticobiliary Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
,
Shirin Djalalinia
4   Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
,
Amirmasoud Kazemzadeh Houjaghan
1   Liver and Pancreaticobiliary Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
,
Monica Gaidhane
5   Division of Gastroenterology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
,
Michel Kahaleh
5   Division of Gastroenterology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background and study aims Treatment of necrotizing pancreatitis is changed over the past two decades with the availability of endoscopic, and minimally invasive surgical approaches. The aim of this systematic review was to assess outcomes of endoscopic drainage, and different types of surgical drainage approaches in necrotizing pancreatitis.

Methods Medline, Embase, Scopus, and Web of Science were searched from 1998 to 2020 to assess outcomes in endoscopic drainage and various surgical drainage procedures. The assessed variables consisted of mortality, development of pancreatic or enteric fistula, new onset diabetes mellitus, and exocrine pancreatic insufficiency.

Results One hundred seventy studies comprising 11,807 patients were included in the final analysis. The pooled mortality rate was 22 % (95 % confidence interval [CI]: 19%–26 %) in the open surgery (OS), 8 % (95 %CI:5 %–11 %) in minimally invasive surgery (MIS), 13 % (95 %CI: 9 %–18 %) in step-up approach, and 3 % (95 %CI:2 %–4 %) in the endoscopic drainage (ED). The pooled rate of fistula formation was 35 % (95 %CI:28 %–41 %) in the OS, 17 % (95 %CI: 12%–23 %) in MIS, 17 % (95 %CI: 9 %–27 %) in step-up approach, and 2 % (95 %CI: 0 %–4 %) in ED. There were 17 comparative studies comparing various surgical drainage methods with ED. The mortality rate was significantly lower in ED compared to OS (risk ratio [RR]: 30; 95 %CI: 0.20–0.45), and compared to MIS (RR: 0.40; 95 %CI: 0.26–0.6). Also, the rate of fistula formation was lower in ED compared to all other surgical drainage approaches.

Conclusions This systematic review demonstrated lower rate of fistula formation with ED compared to various surgical drainage methods. A lower rate of mortality with ED was also observed in observational studies. PROSPERO Identifier: CRD42020139354

Supplementary material



Publication History

Received: 09 July 2021

Accepted after revision: 10 November 2021

Article published online:
14 April 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Lankisch PG, Apte M, Banks PA. Acute pancreatitis. Lancet 2015; 386: 85-96
    CrossrefPubMedGoogle Scholar
  • 2 Baron TH, DiMaio CJ, Wang AY. et al. American Gastroenterological Association Clinical Practice Update: Management of Pancreatic Necrosis. Gastroenterology 2020; 158: 67-75.e61
    CrossrefPubMedGoogle Scholar
  • 3 Mouli VP, Sreenivas V, Garg PK. Efficacy of Conservative treatment, without necrosectomy, for infected pancreatic necrosis: a systematic review and meta-analysis. Gastroenterology 2013; 144: 333-340e2
    CrossrefPubMedGoogle Scholar
  • 4 Beger HG, Bittner R, Block S. et al. Bacterial contamination of pancreatic necrosis. A prospective clinical study. Gastroenterology 1986; 91: 433-438
    CrossrefPubMedGoogle Scholar
  • 5 Beger HG, Rau BM. Severe acute pancreatitis: Clinical course and management. World J Gastroenterol 2007; 13: 5043-5051
    CrossrefPubMedGoogle Scholar
  • 6 van Baal MC, van Santvoort HC, Bollen TL. et al. Systematic review of percutaneous catheter drainage as primary treatment for necrotizing pancreatitis. Br J Surg 2011; 98: 18-27
    CrossrefPubMedGoogle Scholar
  • 7 van Santvoort HC, Besselink MG, Bakker OJ. et al. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med 2010; 362: 1491-1502
    CrossrefPubMedGoogle Scholar
  • 8 van Brunschot S, van Grinsven J, van Santvoort HC. et al. Endoscopic or surgical step-up approach for infected necrotising pancreatitis: a multicentre randomised trial. Lancet 2018; 391: 51-58
    CrossrefPubMedGoogle Scholar
  • 9 Bang JY, Arnoletti JP, Holt BA. et al. An endoscopic transluminal approach, compared with minimally invasive surgery, reduces complications and costs for patients with necrotizing pancreatitis. Gastroenterology 2019; 156: 1027-1040.e1023
    CrossrefPubMedGoogle Scholar
  • 10 Haney CM, Kowalewski KF, Schmidt MW. et al. Endoscopic versus surgical treatment for infected necrotizing pancreatitis: a systematic review and meta-analysis of randomized controlled trials. Surg Endosc 2020; 34: 2429-2444
    CrossrefPubMedGoogle Scholar
  • 11 Puli SR, Graumlich JF, Pamulaparthy SR. et al. Endoscopic transmural necrosectomy for walled-off pancreatic necrosis: a systematic review and meta-analysis. Can J Gastroenterol Hepatol 2014; 28: 50-53
    CrossrefPubMedGoogle Scholar
  • 12 Luigiano C, Pellicano R, Fusaroli P. et al. Pancreatic necrosectomy: an evidence-based systematic review of the levels of evidence and a comparison of endoscopic versus non-endoscopic techniques. Minerva Chir 2016; 71: 262-269
    PubMedGoogle Scholar
  • 13 van Brunschot S, Fockens P, Bakker OJ. et al. Endoscopic transluminal necrosectomy in necrotising pancreatitis: a systematic review. Surg Endosc 2014; 28: 1425-1438
    CrossrefPubMedGoogle Scholar
  • 14 Moher D, Shamseer L, Clarke M. et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 2015; 4: 1
    CrossrefPubMedGoogle Scholar
  • 15 Gambiez LP, Denimal FA, Porte HL. et al. Retroperitoneal approach and endoscopic management of peripancreatic necrosis collections. Arch Surg 1998; 133: 66-72
    CrossrefPubMedGoogle Scholar
  • 16 Schulz KF, Altman DG, Moher D. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMJ 2010; 340: c332
    CrossrefPubMedGoogle Scholar
  • 17 von Elm E, Altman DG, Egger M. et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med 2007; 147: 573-577
    Google Scholar
  • 18 DerSimonian R, Laird N. Meta-analysis in clinical trials revisited. Contemp Clin Trials 2015; 45: 139-145
    CrossrefPubMedGoogle Scholar
  • 19 Nyaga VN, Arbyn M, Aerts M. Metaprop: a Stata command to perform meta-analysis of binomial data. Arch Public Health 2014; 72: 39
    CrossrefPubMedGoogle Scholar
  • 20 Marín-Martínez F, Sánchez-Meca J. Averaging dependent effect sizes in meta-analysis: a cautionary note about procedures. Span J Psychol 1999; 2: 32-38
    CrossrefPubMedGoogle Scholar
  • 21 Higgins JP, Thompson SG, Deeks JJ. et al. Measuring inconsistency in meta-analyses. BMJ 2003; 327: 557-560
    CrossrefPubMedGoogle Scholar
  • 22 Harbord RM, Egger M, Sterne JA. A modified test for small-study effects in meta-analyses of controlled trials with binary endpoints. Stat Med 2006; 25: 3443-3457
    CrossrefPubMedGoogle Scholar
  • 23 Voermans RP, Ponchon T, Schumacher B. et al. Forward-viewing versus oblique-viewing echoendoscopes in transluminal drainage of pancreatic fluid collections: a multicenter, randomized, controlled trial. Gastrointest Endosc 2011; 74: 1285-1293
    CrossrefPubMedGoogle Scholar
  • 24 Bang JY, Navaneethan U, Hasan MK. et al. Non-superiority of lumen-apposing metal stents over plastic stents for drainage of walled-off necrosis in a randomised trial. Gut 2019; 68: 1200-1209
    CrossrefPubMedGoogle Scholar
  • 25 van Brunschot S, Hollemans RA, Bakker OJ. et al. Minimally invasive and endoscopic versus open necrosectomy for necrotising pancreatitis: a pooled analysis of individual data for 1980 patients. Gut 2018; 67: 697-706
    PubMedGoogle Scholar
  • 26 Bakker OJ, van Santvoort HC, van Brunschot S. et al. Endoscopic transgastric vs surgical necrosectomy for infected necrotizing pancreatitis: a randomized trial. JAMA 2012; 307: 1053-1061
    CrossrefPubMedGoogle Scholar
  • 27 Garg PK, Meena D, Babu D. et al. Endoscopic versus laparoscopic drainage of pseudocyst and walled-off necrosis following acute pancreatitis: a randomized trial. Surg Endosc 2020; 34: 1157-1166
    CrossrefPubMedGoogle Scholar
  • 28 Peery AF, Crockett SD, Barritt AS. et al. Burden of gastrointestinal, liver, and pancreatic diseases in the United States. Gastroenterology 2015; 149: 1731-1741.e1733
    CrossrefPubMedGoogle Scholar
  • 29 Boxhoorn L, Voermans RP, Bouwense SA. et al. Acute pancreatitis. Lancet 2020; 396: 726-734
    CrossrefPubMedGoogle Scholar
  • 30 Sarr MG. Minimal access necrosectomy: the newest advance of many in the treatment of necrotising pancreatitis. Gut 2018; 67: 599-600
    PubMedGoogle Scholar
  • 31 Garg PK, Zyromski NJ, Freeman ML. Infected Necrotizing pancreatitis: Evolving interventional strategies from minimally invasive surgery to endoscopic therapy-evidence mounts, but one size does not fit all. Gastroenterology 2019; 156: 867-871
    CrossrefPubMedGoogle Scholar
  • 32 Chandrasekaran P, Gupta R, Shenvi S. et al. Prospective comparison of long term outcomes in patients with severe acute pancreatitis managed by operative and non operative measures. Pancreatology 2015; 15: 478-484
    CrossrefPubMedGoogle Scholar
  • 33 van der Wiel SE, May A, Poley JW. et al. Preliminary report on the safety and utility of a novel automated mechanical endoscopic tissue resection tool for endoscopic necrosectomy: a case series. Endosc Int Open 2020; 8: E274-e280
    Article in Thieme ConnectPubMedGoogle Scholar
  • 34 Stassen PMC, de Jonge PJF, Bruno MJ. et al. Safety and efficacy of a novel resection system for direct endoscopic necrosectomy of walled-off pancreas necrosis: a prospective, international, multicenter trial. Gastrointest Endosc 2021; DOI: 10.1016/j.gie.2021.09.025.
    CrossrefPubMedGoogle Scholar