We carried out the first meta-analysis comparing the technical success and clinical outcomes of endoscopic ultrasound-guided drainage (EUD) and conventional transmural drainage (CTD) for pancreatic pseudocysts. We searched PubMed, Embase, Scopus, and the Cochrane library to identify relevant prospective trials. The technical success rate, short-term (4-6 weeks) success, and long-term (at 6 months) success in symptoms and the radiologic resolution of pseudocysts, complication rates, and death rates were compared. Two eligible randomized-controlled trials and two prospective studies including 229 patients were retrieved. The technical success rate was significantly higher for EUD than for CTD [risk ratio (RR)=12.38, 95% confidence interval (CI): 1.39-110.22]. When CTD failed because of the nonbulging nature of pseudocysts, a crossover was carried out to EUD (n=18), which was successfully performed in all these cases. All patients with portal hypertension and bleeding tendency were subjected to EUD to avoid severe complications. EUD was not superior to CTD in terms of short-term success (RR=1.03, 95% CI: 0.95-1.11) or long-term success (RR=0.98, 95% CI: 0.76-1.25). The overall complications were similar in both groups (RR=0.98, 95% CI: 0.52-1.86). The most common complications were bleeding and infection. There were two deaths from bleeding after CTD. The short-term and long-term treatment success of both methods is comparable only if proper drainage modality is selected in specific clinical situations. For bulging pseudocysts, either EUD or CTD can be selected whereas EUD is the treatment of choice for nonbulging pseudocysts, portal hypertension, or coagulopathy.

译文

我们进行了首次荟萃分析,比较了内镜超声引导引流 (EUD) 和常规透壁引流 (CTD) 治疗胰腺假性囊肿的技术成功和临床结果。我们搜索了PubMed,Embase,Scopus和Cochrane图书馆,以确定相关的前瞻性试验。比较了症状的技术成功率,短期 (4-6周) 成功率和长期 (6个月) 成功率以及假性囊肿的放射学分辨率,并发症发生率和死亡率。检索了两项符合条件的随机对照试验和两项包括229名患者的前瞻性研究。EUD的技术成功率明显高于CTD [风险比 (RR)= 12.38,95% 置信区间 (CI): 1.39-110.22]。当由于假性囊肿的非膨出性而导致CTD失败时,对EUD进行了交叉 (n = 18),在所有这些情况下均成功进行了交叉。所有有门静脉高压症和出血倾向的患者均接受EUD治疗,以避免严重的并发症。就短期成功率 (RR = 1.03,95% CI: 0.95-1.11) 或长期成功率 (RR = 0.98,95% CI: 0.76-1.25) 而言,EUD并不优于CTD。两组的总体并发症相似 (RR = 0.98,95% CI: 0.52-1.86)。最常见的并发症是出血和感染。CTD后有2例死于出血。只有在特定的临床情况下选择适当的引流方式,两种方法的短期和长期治疗成功才具有可比性。对于膨出性假性囊肿,可以选择EUD或CTD,而EUD是治疗非膨出性假性囊肿,门静脉高压症或凝血病的首选方法。

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