Management strategies for pancreatic pseudocysts

Area of Science:

• Gastroenterology
• Surgical Innovation
• Clinical Trial Analysis

Background:

• Pancreatic pseudocysts are fluid collections requiring treatment, but optimal management remains uncertain.
• This review addresses the benefits and harms of various pancreatic pseudocyst treatment strategies.

Purpose of the Study:

• To assess the benefits and harms of different management strategies for pancreatic pseudocysts.
• Evaluate outcomes of endoscopic ultrasound (EUS)-guided drainage, endoscopic drainage, and open surgical drainage.

Main Methods:

• Systematic review of randomized controlled trials (RCTs) up to September 2015.
• Included 4 RCTs with 177 participants comparing various drainage techniques.
• Data extracted and analyzed using odds ratios and mean differences; indirect comparisons performed due to limited direct evidence.

Main Results:

• Low to very low-quality evidence suggests EUS-guided drainage with nasocystic drainage may reduce adverse events and hospital stays.
• Open surgical drainage was associated with worse short-term quality of life and higher costs compared to EUS-guided drainage.
• Endoscopic drainage showed a higher need for additional invasive procedures compared to EUS-guided drainage.

Conclusions:

• Evidence quality is low, with imprecise estimates for mortality and serious adverse events.
• EUS-guided drainage with nasocystic drainage appears beneficial for reducing adverse events and hospital stays.
• Further high-quality RCTs are crucial to compare EUS-guided drainage techniques and establish optimal patient-oriented outcomes.