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

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 I ²% 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.