Performance and Safety of EUS Ablation Techniques for Pancreatic Cystic Lesions: A Systematic Review and Meta-Analysis
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...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-05-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/15/9/2627 |
| _version_ | 1797602877845274624 |
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| author | Apostolis Papaefthymiou Gavin J. Johnson Marcello Maida Paraskevas Gkolfakis Daryl Ramai Antonio Facciorusso Marianna Arvanitakis Alexander Ney Giuseppe K. Fusai Adrian Saftoiu Daniela Tabacelia Simon Phillpotts Michael H. Chapman George J. Webster Stephen P. Pereira |
| author_facet | Apostolis Papaefthymiou Gavin J. Johnson Marcello Maida Paraskevas Gkolfakis Daryl Ramai Antonio Facciorusso Marianna Arvanitakis Alexander Ney Giuseppe K. Fusai Adrian Saftoiu Daniela Tabacelia Simon Phillpotts Michael H. Chapman George J. Webster Stephen P. Pereira |
| author_sort | Apostolis Papaefthymiou |
| collection | DOAJ |
| description | 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: 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: 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<sup>2</sup> = 93.7%), and the respective partial response rate was 30% (95%CI: 20–39; 206/767; I<sup>2</sup> = 86.1%). Adverse events were recorded in 14% (95%CI: 8–20; 164/840; I<sup>2</sup> = 87.2%) of cases, rated as mild in 10% (95%CI: 5–15; 128/840; I<sup>2</sup> = 86.7%), and severe in 4% (95%CI: 3–5; 36/840; I<sup>2</sup> = 0%). The subgroup analysis for the primary outcome revealed rates of 70% (95%CI: 64–76; I<sup>2</sup> = 42.3%) for ethanol/paclitaxel, 44% (95%CI: 33–54; I<sup>2</sup>= 0%) for lauromacrogol, 32% (95%CI: 27–36; I<sup>2</sup> = 88.4%) for ethanol, and 13% (95%CI: 4–22; I<sup>2</sup> = 95.8%) for RFA. Considering adverse events, the ethanol-based subgroup rated the highest percentage (16%; 95%CI: 13–20; I<sup>2</sup> = 91.0%). Conclusion: 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. |
| first_indexed | 2024-03-11T04:22:43Z |
| format | Article |
| id | doaj.art-ef24c43be1c644c4966de84e7f8463d1 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-11T04:22:43Z |
| publishDate | 2023-05-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-ef24c43be1c644c4966de84e7f8463d12023-11-17T22:42:21ZengMDPI AGCancers2072-66942023-05-01159262710.3390/cancers15092627Performance and Safety of EUS Ablation Techniques for Pancreatic Cystic Lesions: A Systematic Review and Meta-AnalysisApostolis Papaefthymiou0Gavin J. Johnson1Marcello Maida2Paraskevas Gkolfakis3Daryl Ramai4Antonio Facciorusso5Marianna Arvanitakis6Alexander Ney7Giuseppe K. Fusai8Adrian Saftoiu9Daniela Tabacelia10Simon Phillpotts11Michael H. Chapman12George J. Webster13Stephen P. Pereira14Pancreaticobiliary Medicine Unit, University College London Hospitals (UCLH), London NW1 2BU, UKPancreaticobiliary Medicine Unit, University College London Hospitals (UCLH), London NW1 2BU, UKGastroenterology and Endoscopy Unit, S. Elia-Raimondi Hospital, 93100 Caltanissetta, ItalyDepartment of Gastroenterology, General Hospital of Nea Ionia “Konstantopoulio-Patision”, 14233 Athens, GreeceGastroenterology and Hepatology, University of Utah Health, Salt Lake City, UT 84132, USAGastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, 37920 Foggia, ItalyDepartment of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, 1070 Brussels, BelgiumInstitute for Liver and Digestive Health, University College London, London NW3 2PF, UKDepartment of HPB Surgery and Liver Transplantation, Royal Free Hospital, London NW3 2QG, UKResearch Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy “Carol Davila”, 4192910 Bucharest, RomaniaResearch Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy “Carol Davila”, 4192910 Bucharest, RomaniaPancreaticobiliary Medicine Unit, University College London Hospitals (UCLH), London NW1 2BU, UKPancreaticobiliary Medicine Unit, University College London Hospitals (UCLH), London NW1 2BU, UKPancreaticobiliary Medicine Unit, University College London Hospitals (UCLH), London NW1 2BU, UKPancreaticobiliary Medicine Unit, University College London Hospitals (UCLH), London NW1 2BU, UKBackground: 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: 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: 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<sup>2</sup> = 93.7%), and the respective partial response rate was 30% (95%CI: 20–39; 206/767; I<sup>2</sup> = 86.1%). Adverse events were recorded in 14% (95%CI: 8–20; 164/840; I<sup>2</sup> = 87.2%) of cases, rated as mild in 10% (95%CI: 5–15; 128/840; I<sup>2</sup> = 86.7%), and severe in 4% (95%CI: 3–5; 36/840; I<sup>2</sup> = 0%). The subgroup analysis for the primary outcome revealed rates of 70% (95%CI: 64–76; I<sup>2</sup> = 42.3%) for ethanol/paclitaxel, 44% (95%CI: 33–54; I<sup>2</sup>= 0%) for lauromacrogol, 32% (95%CI: 27–36; I<sup>2</sup> = 88.4%) for ethanol, and 13% (95%CI: 4–22; I<sup>2</sup> = 95.8%) for RFA. Considering adverse events, the ethanol-based subgroup rated the highest percentage (16%; 95%CI: 13–20; I<sup>2</sup> = 91.0%). Conclusion: 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.https://www.mdpi.com/2072-6694/15/9/2627pancreatic cystEUSablationethanolRFApaclitaxel |
| spellingShingle | Apostolis Papaefthymiou Gavin J. Johnson Marcello Maida Paraskevas Gkolfakis Daryl Ramai Antonio Facciorusso Marianna Arvanitakis Alexander Ney Giuseppe K. Fusai Adrian Saftoiu Daniela Tabacelia Simon Phillpotts Michael H. Chapman George J. Webster Stephen P. Pereira Performance and Safety of EUS Ablation Techniques for Pancreatic Cystic Lesions: A Systematic Review and Meta-Analysis Cancers pancreatic cyst EUS ablation ethanol RFA paclitaxel |
| title | Performance and Safety of EUS Ablation Techniques for Pancreatic Cystic Lesions: A Systematic Review and Meta-Analysis |
| title_full | Performance and Safety of EUS Ablation Techniques for Pancreatic Cystic Lesions: A Systematic Review and Meta-Analysis |
| title_fullStr | Performance and Safety of EUS Ablation Techniques for Pancreatic Cystic Lesions: A Systematic Review and Meta-Analysis |
| title_full_unstemmed | Performance and Safety of EUS Ablation Techniques for Pancreatic Cystic Lesions: A Systematic Review and Meta-Analysis |
| title_short | Performance and Safety of EUS Ablation Techniques for Pancreatic Cystic Lesions: A Systematic Review and Meta-Analysis |
| title_sort | performance and safety of eus ablation techniques for pancreatic cystic lesions a systematic review and meta analysis |
| topic | pancreatic cyst EUS ablation ethanol RFA paclitaxel |
| url | https://www.mdpi.com/2072-6694/15/9/2627 |
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