Clinical presentation and management and outcomes of disconnected pancreatic duct syndrome: a systematic review and meta-analysis

Abstract Background Disconnected pancreatic duct syndrome (DPDS) is a complication of acute necrotizing pancreatitis in the neck and body of the pancreas often manifesting as persistent pancreatic fluid collection (PFC) or external pancreatic fistula (EPF). This systematic review and pairwise meta-analysis aimed to review the definitions, clinical presentation, intervention, and outcomes for DPDS. Methods The PubMed, EMBASE, MEDLINE, and SCOPUS databases were systematically searched until February 2020 using the PRISMA framework. A meta-analysis was performed to assess the success rates of endoscopic and surgical interventions for the treatment of DPDS. Success of DPDS treatment was defined as long-term resolution of symptoms without recurrence of PFC, EPF, or pancreatic ascites. Results Thirty studies were included in the quantitative analysis comprising 1355 patients. Acute pancreatitis was the most common etiology (95.3%, 936/982), followed by chronic pancreatitis (3.1%, 30/982). DPDS commonly presented with PFC (83.2%, 948/1140) and EPF (13.4%, 153/1140). There was significant heterogeneity in the definition of DPDS in the literature. Weighted success rate of endoscopic transmural drainage (90.6%, 95%-CI 81.0–95.6%) was significantly higher than transpapillary drainage (58.5%, 95%-CI 36.7–77.4). Pairwise meta-analysis showed comparable success rates between endoscopic and surgical intervention, which were 82% (weighted 95%-CI 68.6–90.5) and 87.4% (95%-CI 81.2–91.8), respectively (P = 0.389). Conclusions Endoscopic transmural drainage was superior to transpapillary drainage for the management of DPDS. Endoscopic and surgical interventions had comparable success rates. The significant variability in the definitions and treatment strategies for DPDS warrant standardisation for further research.

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Endoscopic Transmural Drainage is Associated With Improved Outcomes in Disconnected Pancreatic Duct Syndrome: A Systematic Review and Meta-analysis

10.21203/rs.3.rs-60493/v1 ◽

2020 ◽

Author(s):

Sanjay Pandanaboyana ◽

Eric Chong Jing Fu ◽

Chathura Bathiya Ratnayake ◽

Samantha Saikia ◽

Manu Nayar ◽

...

Keyword(s):

Systematic Review ◽

Pancreatic Duct ◽

Meta Analysis ◽

Fluid Collection ◽

Significant Heterogeneity ◽

Success Rates ◽

Surgical Interventions ◽

Transmural Drainage ◽

Transpapillary Drainage ◽

Duct Syndrome

Abstract BackgroundDisconnected pancreatic duct syndrome (DPDS) is a complication of acute necrotizing pancreatitis in the neck and body of the pancreas often manifesting as persistent pancreatic fluid collection (PFC) or external pancreatic fistula (EPF). This systematic review and pairwise meta-analysis aim to review the definitions, clinical presentation, intervention, and outcomes for DPDS. MethodsThe PubMed, EMBASE, MEDLINE, and SCOPUS databases were systematically searched until February 2020 using the PRISMA framework. A meta-analysis was performed to assess the success rates of endoscopic and surgical interventions for the treatment of DPDS. Success of DPDS treatment was defined as long-term resolution of symptoms without recurrence of PFC, EPF, or pancreatic ascites.ResultsThirty studies were included in the quantitative analysis comprising 1355 patients. Acute pancreatitis was the most common etiology (95.2%, 918/964), followed by chronic pancreatitis (3.1%, 30/964). DPDS commonly presented with PFC (77.3%,728/942) and EPF (18.6%, 175/942). There was significant heterogeneity in the definition of DPDS in the literature. Weighted success rate of endoscopic transmural drainage (90.6%, 95%-CI: 81.0-95.6%) was significantly higher than transpapillary drainage (58.5%, 95%-CI 36.7-77.4). Pairwise meta-analysis showed comparable success rates between endoscopic and surgical intervention, which were 82% (weighted 95%-CI 68.6-90.5) and 87.4% (95%-CI 81.2-91.8), respectively (P=0.389). Conclusions Endoscopic transmural drainage was superior to transpapillary drainage for the management of DPDS. Endoscopic and surgical interventions had comparable success rates. The significant variability in the definitions and treatment strategies for DPDS warrant standardisation for further research.

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Disconnected pancreatic duct syndrome and outcomes of endoscopic ultrasound‐guided treatment of pancreatic fluid collections: A systematic review and meta‐analysis

Digestive Endoscopy ◽

10.1111/den.14142 ◽

2021 ◽

Author(s):

Tsuyoshi Hamada ◽

Takuji Iwashita ◽

Tomotaka Saito ◽

Hideyuki Shiomi ◽

Mamoru Takenaka ◽

...

Keyword(s):

Systematic Review ◽

Pancreatic Duct ◽

Endoscopic Ultrasound ◽

Meta Analysis ◽

Ultrasound Guided ◽

Pancreatic Fluid Collections ◽

Pancreatic Fluid ◽

Fluid Collections ◽

Duct Syndrome

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Endoscopic transmural drainage is associated with improved outcomes in disconnected pancreatic duct syndrome: a systematic review and meta-analysis

HPB ◽

10.1016/j.hpb.2021.08.247 ◽

2021 ◽

Vol 23 ◽

pp. S792-S793

Author(s):

E. Chong ◽

B. Ratnayake ◽

S. Saikia ◽

M. Nayar ◽

K. Oppong ◽

...

Keyword(s):

Systematic Review ◽

Pancreatic Duct ◽

Meta Analysis ◽

Improved Outcomes ◽

Transmural Drainage ◽

Duct Syndrome

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Correlation of MRI-detected vulnerable carotid plaques with clinical presentation: a systematic review and meta-analysis

Journal of Neurosurgical Sciences ◽

10.23736/s0390-5616.19.04820-3 ◽

2020 ◽

Vol 64 (3) ◽

Author(s):

Seyed M. Seyedsaadat ◽

Asim Rizvi ◽

Muayad Alzuabi ◽

Sagar B. Dugani ◽

M. Hassan Murad ◽

...

Keyword(s):

Systematic Review ◽

Clinical Presentation ◽

Meta Analysis ◽

Carotid Plaques

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Prevalence and characteristics of brain arteriovenous malformations in hereditary hemorrhagic telangiectasia: a systematic review and meta-analysis

Journal of Neurosurgery ◽

10.3171/2016.7.jns16847 ◽

2017 ◽

Vol 127 (2) ◽

pp. 302-310 ◽

Cited By ~ 20

Author(s):

Waleed Brinjikji ◽

Vivek N. Iyer ◽

Christopher P. Wood ◽

Giuseppe Lanzino

Keyword(s):

Systematic Review ◽

Hereditary Hemorrhagic Telangiectasia ◽

Arteriovenous Malformations ◽

Clinical Presentation ◽

Meta Analysis ◽

Prevalence Rates ◽

Brain Avm ◽

Martin Grade ◽

Cerebral Avms ◽

Brain Avms

OBJECTIVEPatients with hereditary hemorrhagic telangiectasia (HHT) are known to suffer from high rates of cerebral arteriovenous malformations (AVMs). The authors performed a systematic review and meta-analysis of the literature examining prevalence rates, characteristics, and clinical presentation of cerebral AVMs in the HHT population.METHODSTo identify studies on AVM prevalence and characteristics in the HHT population, 4 databases (MEDLINE, EMBASE, Scopus and Web of Science) were searched by a reference librarian with over 30 years experience in systematic reviews and meta-analysis. The search period was January 1, 1990–March 2016. The following search terms were used: hereditary hemorrhagic telangiectasia, Osler-Weber-Rendu syndrome, AVM, brain AVM, arteriovenous malformation, arteriovenous fistula, prevalence, and epidemiology. The authors identified studies that examined the prevalence rates, characteristics, and clinical presentation of cerebral AVMs in patients with HHT. They assessed overall AVM prevalence rates as well as prevalence rates by age, sex, HHT type, and country/region. They also systematically reviewed the characteristics of AVMs, including rupture status, location, clinical presentation, angioarchitecture, and Spetzler-Martin grade. Data were analyzed using a random-effects meta-analysis model.RESULTSThirty-nine studies were included in this meta-analysis. Thirty studies examined brain AVM prevalence rates in various HHT patient populations, and 18 studies examined AVM clinical and angiographic characteristics (9 studies examined both prevalence rates and AVM characteristics). The prevalence of brain AVMs in HHT patients was 10.4% (95% CI 7.9%–13.0%) with no significant difference between males (8.5%, 95% CI 4.9%–12.0%) and females (11.0%, 95% CI 5.9%–16.1%). Patients with HHT Type 1 (HHT1) had a significantly higher brain AVM prevalence (13.4%, 95% CI 9.5%–17.4%) compared with those with HHT Type 2 (HHT2) (2.4%, 95% CI 1.0%–3.8%) (p < 0.0001). In 55.2% (95% CI 38.3%–72.1%) of cases, the AVMs were symptomatic. Spetzler-Martin grade was 2 or less in 86.9% (95% CI 67.5%–95.2%) of patients.CONCLUSIONSThe prevalence of brain AVMs in the HHT population is about 10%. HHT1 patients are significantly more likely to have brain AVMs than HHT2 patients. Most AVMs in the HHT population are symptomatic. The Spetzler-Martin grade for these lesions is 2 or less in nearly 90% of patients.

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Efficacy of pancreatoscopy for pancreatic duct stones: A systematic review and meta-analysis

World Journal of Gastroenterology ◽

10.3748/wjg.v26.i34.5207 ◽

2020 ◽

Vol 26 (34) ◽

pp. 5207-5219

Author(s):

Syed M Saghir ◽

Harmeet S Mashiana ◽

Babu P Mohan ◽

Banreet S Dhindsa ◽

Amaninder Dhaliwal ◽

...

Keyword(s):

Systematic Review ◽

Pancreatic Duct ◽

Meta Analysis ◽

Pancreatic Duct Stones

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Laparoscopic Pancreaticoduodenectomy Versus Conventional Open Approach for Patients With Pancreatic Duct Adenocarcinoma: An Up-to-Date Systematic Review and Meta-Analysis

Frontiers in Oncology ◽

10.3389/fonc.2021.749140 ◽

2021 ◽

Vol 11 ◽

Author(s):

Qingbo Feng ◽

Wenwei Liao ◽

Zechang Xin ◽

Hongyu Jin ◽

Jinpeng Du ◽

...

Keyword(s):

Systematic Review ◽

Overall Survival ◽

Lymph Node ◽

Blood Loss ◽

Survival Time ◽

Pancreatic Duct ◽

Meta Analysis ◽

R0 Resection ◽

Node Dissection ◽

Pancreatic Duct Adenocarcinoma

BackgroundTo compare perioperative and oncological outcomes of pancreatic duct adenocarcinoma (PDAC) after laparoscopic versus open pancreaticoduodenectomy (LPD vs. OPD), we performed a meta-analysis of currently available propensity score matching studies and large-scale retrospective cohorts to compare the safety and overall effect of LPD to OPD for patients with PDAC.MethodsA meta-analysis was registered at PROSPERO and the registration number is CRD42021250395. PubMed, Web of Science, EMBASE, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were searched based on a defined search strategy to identify eligible studies before March 2021. Data on operative times, blood loss, 30-day mortality, reoperation, length of hospital stay (LOS), overall morbidity, Clavien–Dindo ≥3 complications, postoperative pancreatic fistula (POPF), blood transfusion, delayed gastric emptying (DGE), postpancreatectomy hemorrhage (PPH), and oncologic outcomes (R0 resection, lymph node dissection, overall survival, and long-term survival) were subjected to meta-analysis.ResultsOverall, we identified 10 retrospective studies enrolling a total of 11,535 patients (1,514 and 10,021 patients underwent LPD and OPD, respectively). The present meta-analysis showed that there were no significant differences in overall survival time, 1-year survival, 2-year survival, 30-day mortality, Clavien-Dindo ≥3 complications, POPF, DGE, PPH, and lymph node dissection between the LPD and OPD groups. Nevertheless, compared with the OPD group, LPD resulted in significantly higher rate of R0 resection (OR: 1.22; 95% CI 1.06–1.40; p = 0.005), longer operative time (WMD: 60.01 min; 95% CI 23.23–96.79; p = 0.001), lower Clavien–Dindo grade ≥III rate (p = 0.02), less blood loss (WMD: −96.49 ml; 95% CI −165.14 to −27.83; p = 0.006), lower overall morbidity rate (OR: 0.65; 95% CI 0.50 to 0.85; p = 0.002), shorter LOS (MD = −2.73; 95% CI −4.44 to −1.03; p = 0.002), higher 4-year survival time (p = 0.04), 5-year survival time (p = 0.001), and earlier time to starting adjuvant chemotherapy after surgery (OR: −10.86; 95% CI −19.42 to −2.30; p = 0.01).ConclusionsLPD is a safe and feasible alternative to OPD for patients with PDAC, and compared with OPD, LPD seemed to provide a similar OS.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/#recordDetails.

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