Authors: Yeshaswini Reddy, Tulika Chatterjee, Srinivas R Puli.
Background: Pancreatic cyst lesions have increased in incidence due to the widespread use of high-quality imaging worldwide. However, EUS-guided ethanol ablation is emerging in non-surgical candidates as a safe and productive alternative for treating pancreatic cysts. This is an updated meta-analysis and systematic review assessing the safety and outcome of EUS-guided ethanol ablation.
Methods: Selection Criteria included pancreatic cyst ablations with EUS-guided ethanol ablation. Data was collected and extracted from Medline, Pubmed, and Ovid journals. Statistical analysis used Fixed and random effects models to calculate the pooled proportions.
Results: Upon initial search, 1,420 articles were found, out of which 124 articles were selected and reviewed. Data was extracted from 8 studies (n=188) examining EUS-guided ethanol ablation of pancreatic cysts that met the inclusion criteria. The pooled proportion of patients with complete cyst resolution was 56.08% (95% CI = 48.77 to 63.26). Patients with partial resolution of the pancreatic cyst had a pooled proportion of 16.37% (95% CI = 10.46 to 23.30). The pooled proportion of patients with persistent cysts was 24.72% (95% CI = 17.90 to 32.10). The post-procedural complications included pancreatitis, fever, splenic vein thrombosis, and intractable bleeding that was experienced in some patients. This pooled analysis showed the patients' post-procedural pancreatitis in 5.22% (95% CI = 2.45 to 8.95). Fever and splenic vein thrombosis was noted in 1.63% (95% CI = 0.30 to 40). Intractable bleeding was seen at 2.10 % (95% CI = 0.52 to 4.70). Publication bias calculated using the Harbord-Egger bias indicator was -0.92 (95% CI = -8.61 to 6.77, p = 0.77). The Begg-Mazumdar indicator gave Kendall's tau b value of 0.2 (p = 0.90).
Conclusions: EUS-guided ethanol ablation of pancreatic cysts is safe and effective with positive outcomes, especially in non-surgical candidates. This study shows that the intra-procedural and post-procedural complications are low. This modality can be offered as a safe alternative to non-surgical candidates.
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