Clinical outcomes and efficacy of endoscopic ultrasound guided ablation of pancreatic cancer a systematic review and a meta-analysis.

e16261 Background: Endoscopic ultrasound-guided ablation therapy (EUS-A) is a minimally invasive technique increasingly used for the management of surgically unresectable pancreatic cancer. The data on the efficacy and clinical outcome of EUS-A for unresectable pancreatic cancer is lacking. We conducted this systematic review and meta-analysis to evaluate the safety, technical and clinical success of EUS-A therapies specifically for unresectable pancreatic cancer. Methods: Studies were identified with a comprehensive search for EUS-A and pancreatic cancer on PubMed, Google Scholar, Web of Science and Embase data search as of October 2020. The technical and clinical success rates of EUS-A were primary outcomes while adverse events (AEs) rate was secondary outcome. We defined technical success as successful placement of probe within tumor and able to perform ablation regardless of tumor outcome. Clinical success was defined as symptomatic improvement and/or any reduction in tumor size or evidence of necrosis on radiological imaging after EUS-A. A compute pooled analysis was performed using the ‘meta’ package by Schwarzer et al. in the R programming language (version 4.0.2) using random effect model. Results: Nineteen studies including 192 patients (54% females) were included. Common pancreatic tumors were nonfunctional neuroendocrine tumor (NNET) 43.5% (97), followed by locally advanced pancreatic ductal adenocarcinoma (LAPDAC) 27.3% (61), insulinoma 17.9% (40), cystic neoplastic lesions 8.5% (19). The pancreatic head was the most common site of tumor 49.8% (111), followed by body, neck and tail 44.8% (100). EUS-RFA was the most commonly used ablative therapy 63% (12/19 studies), followed by EUS-EA (ethanol ablation) 26% (5/19 studies) while EUS-A using laser and lauromacrogol injection was used in one study each. The mean number of ablation sessions per patient was 1.4 based on the total 243 sessions in 176 patients. The pooled technical success rate of EUS-A was 99.5% [95% CI = 0.90-0.97, I2 = 0%]. The pooled clinical success rate calculated out of total number of pancreatic lesions was 91.1% [95% CI = 0.79-0.92, I2 = 16%]. Clinical improvement in symptoms was reported in 11 studies and a complete resolution or decrease in tumor size was reported in 16 studies. The pooled AEs rate was 22.9% [95% CI = 0.17-0.37, I2 = 43%]. Common AEs were abdominal pain 7.8% (15), pancreatitis 5.2% (10) and pancreatic pseudocyst 2.1% (4). The median follow-up was 9.5 months. Conclusions: EUS-A is a safe and promising modality in the management of unresectable pancreatic cancer with a high technical and clinical success rate. Large prospective studies and clinical trials are required for comparison of clinical outcome of different EUS-A therapies and its widespread application for unresectable pancreatic cancer.

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Efficacy and safety of over-the-scope clips for gastrointestinal bleeding: a systematic review and meta-analysis

Endoscopy ◽

10.1055/a-0994-4361 ◽

2019 ◽

Vol 51 (10) ◽

pp. 941-949 ◽

Cited By ~ 3

Author(s):

Viveksandeep Thoguluva Chandrasekar ◽

Madhav Desai ◽

Muhammad Aziz ◽

Harsh K. Patel ◽

Venkata Subhash Gorrepati ◽

...

Keyword(s):

Systematic Review ◽

Large Scale ◽

Clinical Success ◽

Meta Analysis ◽

Clinical Success Rate ◽

Line Treatment ◽

Gi Bleeding ◽

Technical Success ◽

Primary Hemostasis

Background The over-the-scope clip (OTSC) has been increasingly utilized for the management of gastrointestinal (GI) bleeding. Limited efficacy data are currently available from large-scale studies. Methods An electronic database search was conducted for eligible articles using OTSCs for hemostasis in GI bleeding. The primary outcome was the rate of definitive hemostasis after primary hemostasis and without rebleeding at follow-up. Secondary outcomes were: primary technical success, primary clinical success, rebleeding, and failure rates. Pooled rates were expressed as proportions of patients with events over total patients, 95 % confidence limits (CI) with heterogeneity, and P values of < 0.05 for significance. Results A total of 21 studies (n = 851) were analyzed (62.2 % males), with a median patient age of 69.7 years. The definitive hemostasis rate was 87.8 % (95 %CI 83.7 % – 92 %) after a median follow-up of 56 days. The OTSC was successfully deployed in 97.8 % of patients (95 %CI 96.7 % – 98.9 %) and the primary clinical success rate was 96.6 % (95 %CI 95.1 % – 98.2 %). Rebleeding was seen in 10.3 % of patients (95 %CI 6.5 % – 14.1 %). The failure rate of OTSCs was 9 % (95 %CI 5.2 % – 12.8 %) when used as first-line treatment and 26 % (95 %CI 16.1 % – 36.0 %) when used as second-line treatment. Conclusion This systematic review showed high rates of definitive hemostasis, technical success, and clinical success, along with low rebleeding rates when OTSCs were used for the treatment of GI bleeding. The lack of randomized controlled trials of OTSC vs. other therapies makes comparison with conventional treatment difficult.

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Endoscopic ultrasound-guided gallbladder drainage versus percutaneous cholecystostomy for high risk surgical patients with acute cholecystitis: a systematic review and meta-analysis

Endoscopy ◽

10.1055/a-0929-6603 ◽

2019 ◽

Vol 51 (08) ◽

pp. 722-732 ◽

Cited By ~ 12

Author(s):

Sally Wai-Yin Luk ◽

Shayan Irani ◽

Rajesh Krishnamoorthi ◽

James Yun Wong Lau ◽

Enders Kwok Wai Ng ◽

...

Keyword(s):

Systematic Review ◽

Adverse Events ◽

Acute Cholecystitis ◽

Clinical Success ◽

Meta Analysis ◽

Surgical Patients ◽

Technical Success ◽

Ultrasound Guided ◽

Post Procedure ◽

Hospital Stays

Abstract Background Recent evidence suggests that endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is an effective and safe alternative to percutaneous drainage (PT-GBD). We conducted a systematic review and meta-analysis to compare these two procedures in high risk surgical patients with acute cholecystitis. Methods A comprehensive electronic literature search was conducted for all articles published up to October 2017 to identify comparative studies between EUS-GBD and PT-GBD. A meta-analysis was performed on outcomes including technical success, clinical success, post-procedure adverse events, length of hospital stay, unplanned hospital readmission, need for reintervention, recurrent cholecystitis, and disease- or treatment-related mortality for these two procedures. Results Five comparative studies (206 patients in the EUS-GBD group vs. 289 patients in the PT-GBD group), were included in the final analysis. There were no statistically significant differences in technical success (odds ratio [OR] 0.43, 95 % confidence interval [CI] 0.12 to 1.58; P = 0.21; I 2 = 0 %) and clinical success (OR 1.07, 95 %CI 0.36 to 3.16; P = 0.90; I 2 = 44 %) between the two procedures. EUS-GBD had fewer adverse events than PT-GBD (OR 0.43, 95 %CI 0.18 to 1.00; P = 0.05; I 2 = 66 %). Moreover, patients undergoing EUS-GBD had shorter hospital stays, with pooled standard mean difference of – 2.53 (95 %CI – 4.28 to – 0.78; P = 0.005; I 2 = 98 %), and required significantly fewer reinterventions (OR 0.16, 95 %CI 0.04 to 0.042; P < 0.001; I 2 = 32 %) resulting in significantly fewer unplanned readmissions (OR 0.16, 95 %CI 0.05 to 0.53; P = 0.003; I 2 = 79 %). Conclusions EUS-GBD was associated with lower rates of post-procedure adverse events, shorter hospital stays, and fewer reinterventions and readmissions compared with PT-GBD in patients with acute cholecystitis who were unfit for surgery.

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Efficacy of EUS-RFA in pancreatic tumors: Is it ready for prime time? A systematic review and meta-analysis

Endoscopy International Open ◽

10.1055/a-1221-5012 ◽

2020 ◽

Vol 08 (10) ◽

pp. E1243-E1251

Author(s):

Amaninder Dhaliwal ◽

Sindhura Kolli ◽

Banreet Singhg Dhindsa ◽

Jacqueline Choa ◽

Harmeet Singh Mashiana ◽

...

Keyword(s):

Systematic Review ◽

Success Rate ◽

Clinical Success ◽

Meta Analysis ◽

Locally Advanced ◽

Clinical Success Rate ◽

Pancreatic Tumors ◽

Secondary Outcome ◽

Manual Search ◽

Number Of Patients

Abstract Background and study aims Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) can be used in patients with unresectable pancreatic ductal adenocarcinoma (PDAC). We performed a systematic review and meta-analysis to evaluate the efficacy of EUS-RFA in treatment of locally advanced unresectable PDAC and other pancreatic tumors. Patients and methods A comprehensive search was done of multiple electronic databases and conference proceedings including PubMed, EMBASE, Web of Science databases, Google Scholar and manual search of references (from inception through May 2019) to identify the studies reporting use of EUS-RFA for pancreatic lesions. The primary outcome was to evaluate technical and clinical success of the procedure. The secondary outcome was to study overall adverse events (AEs). Results Thirteen studies reporting 165 EUS-RFA procedures on 134 patients were included. Of 134 patients, 27.94 % (38) had unresectable locally advanced PDAC, 40 % (53) had PNETs, 3 % (4) had metastasis to the pancreas and 30 % (41) had other lesions. The pooled technical success rate calculated out of the total number of procedures was 100 % (95 % CI [99.18 – 100], I2 = 0 %). The pooled clinical success rate calculated out of the total number of patients was 91.58 % (95 % CI [82.5 – 98.08], I2 = 21.5 %). The pooled overall AE rates were 14.67 % (95 % CI [4.77 – 27.46], I2 = 56.19 %) out of which abdominal pain was the most common with 9.82 % (95 % CI [3.34 – 18.24], I2 = 23.76 %). Low to moderate heterogeneity was noted. Conclusion EUS-RFA has high technical (100 %) and clinical success (91.5 %) rates. Further multicenter trials are needed to further validate our findings.

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Posterior Cervical Foraminotomy Via Full-Endoscopic Versus Microendoscopic Approach for Radiculopathy: A Systematic Review and Meta-analysis

January 2018 - Pain Physician ◽

10.36076/ppj/2019.22.41 ◽

2019 ◽

Vol 1 (22;1) ◽

pp. 41-52

Author(s):

Bing Wang

Keyword(s):

Systematic Review ◽

Success Rate ◽

Clinical Success ◽

Meta Analysis ◽

Clinical Success Rate ◽

Cervical Radiculopathy ◽

Reoperation Rate ◽

Significant Difference ◽

Posterior Cervical Foraminotomy ◽

Cervical Foraminotomy

Background: Recently posterior cervical foraminotomy (PCF) performed using a minimally-invasive surgery (MIS) approach for cervical radiculopathy due to lateral disc herniation or osseous foraminal stenosis has gained popularity. As 2 dominating MIS techniques, whether FE-PCF or MI-PCF provides superior clinical outcomes remains controversial. Objectives: To compare clinical success rate, overall incidence of complications and reoperation rate between full-endoscopic posterior cervical foraminotomy (FE-PCF) and microendoscopic posterior cervical foraminotomy (MI-PCF) for cervical radiculopathy. Study Design: A systematic review and meta-analysis. Methods: A literature search of Pubmed, Embase and Web of Science was conducted to identify comparative or single-arm studies concerning FE-PCF or MI-PCF. The pooled results were performed by calculating the effect size based on the logit event rate and reported with 95% confidence intervals (CI). Results: A total of 26 articles with 2003 patients (FE-PCF, 377; MI-PCF, 1626) were included. The pooled clinical success rate was 93.6% (CI: 90.0%~95.9%) for the FE group and 89.9% (CI: 86.6%~92.5%) for the MI group, which was not statistically significant (P = 0.908). Overall complication rates were 6.1% (CI: 3.2%~11.3%) and 3.5% (CI: 2.7%~4.6%) for the FE group and the MI group, respectively, with no significant difference (P = 0.128). Nevertheless, the specific constituents showed apparent disparity, with transient nerve root palsy in the FE group (12/16, 75.0%) and dural tear in the MI group (20/47, 42.6%) being the most commonly reported. the pooled reoperation rate, the FE group (4.8%, CI: 2.9%~7.8%) and the MI group (5.3%, CI: 3.4%~8.2%), also demonstrated no statistical difference (P = 0.741). Limitations: The indirect comparison eroded the reliability of results inevitably due to the paucity of randomized clinical trials or high quality prospective cohort studies. Conclusions: Both FE-PCF and MI-PCF can offer an effective and relatively secure treatment for cervical radiculopathy. There was no significant difference in the pooled outcomes of clinical success rate, complication rate and reoperation rate between the 2 approaches. Key words: Cervical radiculopathy, full-endoscopic, microendoscopic, posterior cervical foraminotomy, clinical outcome, complication, reoperation, meta-analysis

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Long-Term Management of Recurrent Cholecystitis after Initial Conservative Treatment: Endoscopic Transpapillary Gallbladder Stenting

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2018/3983707 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7

Author(s):

Hideki Kamada ◽

Hideki Kobara ◽

Naohito Uchida ◽

Kiyohito Kato ◽

Takayuki Fujimori ◽

...

Keyword(s):

High Risk ◽

Acute Cholecystitis ◽

Success Rate ◽

Clinical Success ◽

Clinical Success Rate ◽

Technical Success ◽

Technical Success Rate ◽

High Risk Patients ◽

Risk Patients

Background. Endoscopic transpapillary gallbladder stenting (ETGBS) is an effective procedure for treating high-risk patients with acute cholecystitis and severe comorbidities. However, the efficacy of ETGBS for recurrent cholecystitis (RC) remains unclear. This study aimed to explore its efficacy in patients with RC for whom cholecystectomy is contraindicated because of its high surgical risk.Methods. Data on 19 high-risk patients who had undergone ETGBS for RC after initial conservative therapy in our institution between June 2006 and May 2012 were retrospectively examined. The primary outcome was the clinical success rate, which was defined as no recurrences of acute cholecystitis after ETGBS until death or the end of the follow-up period. Secondary outcomes were technical success rate and adverse events (AEs).Results. The clinical success rate of ETGBS was 100%, the technical success rate 94.7%, and AE rate 5%: one patient developed procedure-related mild acute pancreatitis. The clinical courses of all patients were as follows: four died of nonbiliary disease, and the remaining 15 were subsequently treated conservatively. The median duration of follow-up was 14.95 months (range 3–42 months).Conclusions. ETGBS is an effective alternative for managing RC in high-risk patients with severe comorbidities.

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Abstract 16680: Endovascular Therapy of Svc Syndrome-a Systematic Review

Circulation ◽

10.1161/circ.142.suppl_3.16680 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Abdul Hussain Azizi ◽

Irfan Shafi ◽

Matthew Zhao ◽

Vladimir Lakhter ◽

Riyaz Bashir

Keyword(s):

Systematic Review ◽

Success Rate ◽

Recurrence Rate ◽

Endovascular Therapy ◽

Meta Analysis ◽

Restenosis Rate ◽

Technical Success ◽

Recurrence Rates ◽

Technical Success Rate ◽

Svc Syndrome

Background: Superior vena cava (SVC) syndrome is caused by the occlusion of the SVC and can result in significant morbidity and mortality. Recently, endovascular therapy (ET) has become the standard of care for majority of these patients. We performed a systematic review of available literature to assess the contemporary technical success rate, restenosis rate, and recurrence rate of SVC syndrome following endovascular intervention. Methods: We searched PubMed, Cochrane Library, and Embase databases from 1988 to 2019 for studies on Endovascular Therapy for SVC syndrome. After screening 709 records, 13 studies were included. Screening was conducted using Rayyan QCRI software for systemic reviews. Studies included full-length journal articles on SVC syndrome and ET among adults (18+ years). Case reports, or case series with <20 patients were excluded. Data analysis was performed using OpenMeta software. Proportions and 95% confidence intervals (CIs) were calculated using random effects models. Heterogeneity among studies was assessed using Q and I 2 statistics. We evaluated the end-points of the technical success, restenosis rate and recurrence rates in SVC syndrome patients after endovascular stenting Results: A meta-analysis of 13 studies included a total of 1024 patients. The results of our meta-analysis show a weighted technical success rate of 98.6% (95% CI 0.97 – 0.99) (Fig. 1A), restenosis rate of 11.8% (95 CI 0.08-0.14) (Fig 1B) and recurrence rate of 9.9% (95% CI 0.06-0.13) (Fig 1C). Our studies had a substantial heterogeneity (I 2 ) of 52-80%. Figures:Figure 1A Figure 1B Figure 1C Conclusions: Our systematic review revealed high technical success rate, low restenosis, and recurrence rates after endovascular therapy supporting the paradigm of endovascular therapy as first line treatment for patients with SVC syndrome. Disclosures: Dr. Bashir has equity interest in Thrombolex Inc.

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The Effect of Celiac Neurolysis and Splanchnicectomy on Survival in Unresectable Pancreatic Cancer: A Systematic Review and Meta-Analysis

Digestive Surgery ◽

10.1159/000520456 ◽

2021 ◽

pp. 1-9

Author(s):

Linhan Ye ◽

Stephan Schorn ◽

Ilaria Pergolini ◽

Okan Safak ◽

Elke Demir ◽

...

Keyword(s):

Systematic Review ◽

Pancreatic Cancer ◽

Fixed Effects ◽

Meta Analysis ◽

Stage Iv ◽

Stage Iii ◽

Cochrane Library ◽

Unresectable Pancreatic Cancer ◽

Relevant Effect ◽

The Impact

Background: Intractable pancreatic pain is one of the most common symptoms of patients with pancreatic ductal adenocarcinoma (PDAC). Celiac neurolysis (CN) and splanchnicectomy were already described as effective methods to manage abdominal pain in unresectable PDAC, but their impact on overall survival (OS) has not yet been established. Objective: We aimed to investigate the impact of CN and splanchnicectomy on the survival of patients with unresectable pancreatic cancer. Methods: A systematic review of PubMed and Cochrane Library according to predefined searching terms was conducted in March 2020. Hazard ratios (HR) of OS data were calculated using the Mantel-Haenszel model for random effects or fixed effects. Result: Four randomized-controlled trials (RCTs) and 2 non-RCTs with a total of 2,507 patients were identified. The overall pooled HR did not reveal any relevant effect of CN and splanchnicectomy on OS (HR: 1.03; 95% CI: 0.81–1.32), which was also underlined by the sensitivity analysis of RCTs (HR: 1.0; 95% CI: 0.72–1.39) and non-RCTs (HR: 1.07; 95% CI: 0.71–1.63). However, subgroup analyses depending on tumor stage revealed that CN or splanchnicectomy was associated with a worsened OS in AJCC (American Joint Committee on Cancer) stage III patients with unresectable PDAC (HR: 1.22; 95% CI: 1.03–1.45), but nor for AJCC stage IV patients (HR: 1.27; 95% CI: 0.9–1.80). Conclusion: Although only few data are currently available, this systematic review with meta-analysis showed that in unresectable PDAC, CN or splanchnicectomy is associated with a worsened survival in stage III PDAC patients, with no effect on stage IV PDAC patients. These data call for caution in the usage of CN or splanchnicectomy in stage III PDAC and for further studies addressing this observation.

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Patient volume and clinical outcome after pancreatic cancer resection: A contemporary systematic review and meta-analysis

Surgery ◽

10.1016/j.surg.2021.11.029 ◽

2022 ◽

Author(s):

Bathiya Ratnayake ◽

Sayali A. Pendharkar ◽

Saxon Connor ◽

Jonathan Koea ◽

Diana Sarfati ◽

...

Keyword(s):

Systematic Review ◽

Pancreatic Cancer ◽

Clinical Outcome ◽

Meta Analysis ◽

Patient Volume ◽

Cancer Resection

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Endoscopic Self-Expandable Metallic Stent Insertion without Fluoroscopic Guidance Is Feasible and Safe for Acute Colonic Obstruction Caused by Colorectal Cancer

Gastroenterology Research and Practice ◽

10.1155/2020/6810164 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Yadong Feng ◽

Qian Yu ◽

Ming Li ◽

Wei Xu ◽

Ye Zhu ◽

...

Keyword(s):

Success Rate ◽

Clinical Success ◽

Colonic Obstruction ◽

Clinical Success Rate ◽

Metallic Stent ◽

Fluoroscopic Guidance ◽

Procedure Time ◽

Technical Success ◽

Short Term ◽

Expandable Metallic Stent

Aims. Endoscopic self-expandable metallic stent (SEMS) insertion for acute colonic obstruction caused by colorectal cancer (CRC) is always performed under fluoroscopic guidance. This study evaluated the feasibility and safety of an endoscopic stenting procedure without fluoroscopic guidance. Methods. A total of 36 patients with an acute colonic obstruction caused by CRC underwent endoscopic SEMS insertion using a colonoscope without fluoroscopic guidance, followed by analyses of the technical and clinical success and short-term complications. Results. Total technical success rate and clinical success rate were 91.7% and 86.1%, respectively. The mean procedure time was 21.2±10.3 minutes. There was no stent dislodgement. One case of hematochezia and two cases of tenesmus occurred in patients with left-sided complete obstructions. No other short-term complications occurred. Procedure time, technical success, and clinical success rate were 16.3±9.4 minutes, 93.1%, and 89.6% for left-sided obstructions, respectively, and were 26.8±10.7 minutes, 85.7%, and 71.4% for right-sided obstructions, respectively. For complete obstructions, procedure time, technical success, and clinical success rate were 22.5±8.9 minutes, 90%, and 83.3%, respectively. In the incomplete cases, procedure time, technical success, and clinical success were 13.5±6.7 minutes, 100%, and 100%, respectively. Technical success, clinical success, and short-term complications were not differed between lesion locations and degrees. Conclusions. This simple technique is feasible and safe for palliation of acute colonic obstruction caused by CRC.

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Efficacy and safety of endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD): A systematic review and meta-analysis of 714 patients

Endoscopy International Open ◽

10.1055/a-1236-3350 ◽

2020 ◽

Vol 08 (11) ◽

pp. E1664-E1672

Author(s):

Saurabh Chandan ◽

Babu P. Mohan ◽

Shahab R. Khan ◽

Lena L. Kassab ◽

Suresh Ponnada ◽

...

Keyword(s):

Adverse Events ◽

Pancreatic Duct ◽

Endoscopic Ultrasound ◽

Clinical Success ◽

Meta Analysis ◽

Fluid Collection ◽

Technical Success ◽

Ultrasound Guided ◽

Anastomotic Strictures ◽

Pancreatic Duct Drainage

Abstract Background and study aims Endoscopic ultrasound guided pancreatic duct drainage (EUS-PDD) is a minimal-invasive therapeutic option to surgery and in patients with failed endoscopic retrograde pancreatography (ERP). The aim of this review was to quantitatively appraise the clinical outcomes of EUS-PDD by meta-analysis methods. Methods We searched multiple databases from inception through March 2020 to identify studies that reported on EUS-PDD. Pooled rates of technical success, successful drainage of pancreatic duct, clinical success, and adverse events were calculated. Study heterogeneity was assessed using I2% and 95 % prediction interval. Results A total of 22 studies (714 patients) were included. The pooled rate of technical success in EUS-PDD was 84.8 % (95 % CI 79.1–89.2). The pooled rate of successful PD drained by EUS-PDD was 77.5 % (95 % CI 63.1–87.4). The pooled rate of clinical success of EUS-PDD was 89.2 % (95 % CI 82.1–93.7). The pooled rate of all adverse events was 18.1 % (95 % CI 14.2–22.9). On sub-group analysis, the pooled technical success and clinical success of EUS-PDD from Japanese data were considerably superior (91.2 %, 83–95.6 & 92.5 %, 83.9–96.7, respectively). The pooled rate of post EUS-PDD acute pancreatitis was 6.6 % (95 % CI 4.5–9.4), bleeding was 4.1 % (95 % CI 2.7–6.2), perforation and/or pneumoperitoneum was 3.1 % (95 % CI 1.9–5), pancreatic leak and/or pancreatic fluid collection was 2.3 % (95 % CI 1.4–4), and infection was 2.8 % (95 % CI 1.7–4.6). Conclusion EUS-PDD demonstrates high technical success and clinical success rates with acceptable adverse events. Technical success was especially high for anastomotic strictures.

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