Short-Term Outcomes of Endoscopic Ultrasound-Guided Pancreatic Cyst Ablation: A Systematic Review and Meta-Analysis

Abstract

Background and aims: Pancreatic cysts (PCs) are increasingly detected through abdominal imaging, prompting exploration of alternatives such as endoscopic ultrasound-guided PC ablation due to the risks and costs associated with surgery. This study conducts a systematic review and meta-analysis of endoscopic ultrasound-guided PC ablation's short-term efficacy and complications for PC management. Methods: A systematic review and meta-analysis were carried out on PubMed, Ovid, Cochrane, and TRIP electronic databases. The primary outcome was cyst resolution (partial and complete) and persistence on imaging 12 months after ablation. The secondary outcome was procedure-related adverse events. Results: Eight studies were eligible for analysis. Complete cyst resolution on imaging 12 months after endoscopic ultrasound ablation was 50% [95% CI 36‒63, I2 = 85.31%]. Partial cyst resolution was 27% [95% CI 15‒41, I2 = 87.07%], and cyst persistence was 17% [95% CI 11‒24, I2 = 62.11%]. The rate of complete resolution varied depending on the treatment agent (for ethanol 29% [95% CI 10‒53]; lauromacrogol 51% [95% Cl 36‒67]; ethanol and paclitaxel 63% [95% CI 48‒76]; paclitaxel and gemcitabine 67% [95% CI 45‒83]; and ethanol, paclitaxel, and gemcitabine 61% [95% CI 39‒80]). Postprocedure adverse events included abdominal pain in 4% [95% CI 0‒11], pancreatitis in 3% [95% CI 1‒5], and fever in 1% [95% CI 0‒3] of all patients. Conclusion: The treatment of pancreatic cysts with endoscopic ultrasound ablation results in acceptable levels of complete resolution, and low incidence of severe adverse events. The effectiveness of this treatment is further enhanced when chemoablative agents are employed.