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Early (<4 Weeks) Versus Standard (≥ 4 Weeks) Endoscopic Drainage of Pancreatic Walled-Off Fluid Collections: A Systematic Review and Meta-analysis

Published:November 14, 2022DOI:https://doi.org/10.1016/j.gie.2022.11.003
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      Abstract

      Background

      Previous studies have demonstrated that the ideal time for drainage of walled off pancreatic fluid collections is 4-6 weeks after its development. However, some pancreatic collections, notably infected pancreatic fluid collections require earlier drainage. Nevertheless, the optimal timing of the first intervention is unclear, and consensus data are sparse. The aim of this study was to evaluate clinical efficacy and safety of endoscopic ultrasound (EUS) - guided drainage of pancreatic fluid collections < than 4 weeks after its development compared to ≥4 weeks after its development.

      Methods

      Search strategies were developed for PubMed, EMBASE, and Cochrane Library databases from inception. Outcomes of interest included technical success defined as successful endoscopic placement of LAMS, clinical success defined as reduction in cystic collection size, and procedure-related adverse events. A random effects model was used for analysis and results were expressed as odds ratio (OR) along with 95% confidence interval (CI).

      Results

      A total of 6 studies (630 patients) were included in our final analysis where 182 patients (28.9%) were enrolled in the early drainage cohort and 448 (71.1%) patients in the standard drainage cohort. The mean fluid collection size was 143.4 ± 18.8 mm for the early cohort vs 128 ± 19.7 mm for the standard cohort. Overall, technical success was equal in both cohorts. Clinical success did not favor either standard drainage or early drainage (OR 0.39; 95% CI 0.13 – 1.22; P=0.11). With regards to adverse events, there was no statistically significant difference in overall adverse events (OR 1.67; 95% CI 0.63 – 4.45; P=0.31) or mortality (OR 1.14; 95% CI 0.29 – 4.48; P=0.85). Hospital stay was longer for patients undergoing early drainage compared to standard drainage (23.7 vs 16.0 days, respectively).

      Conclusions

      Both early (< 4 weeks) and standard (≥ 4 weeks) drainage of walled off pancreatic fluid collections offer similar technical and clinical outcomes. Patients requiring endoscopic drainage should not be delayed for 4 weeks.
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