Performance and Safety of EUS Ablation Techniques for Pancreatic Cystic Lesions: A Systematic Review and Meta-Analysis

Apostolis Papaefthymiou; Gavin J Johnson; Marcello Maida; Paraskevas Gkolfakis; Daryl Ramai; Antonio Facciorusso; Marianna Arvanitakis; Alexander Ney; Giuseppe K Fusai; Adrian Saftoiu; Daniela Tabacelia; Simon Phillpotts; Michael H Chapman; George J Webster; Stephen P Pereira

doi:10.3390/cancers15092627

Performance and Safety of EUS Ablation Techniques for Pancreatic Cystic Lesions: A Systematic Review and Meta-Analysis

Cancers (Basel). 2023 May 5;15(9):2627. doi: 10.3390/cancers15092627.

Authors

Apostolis Papaefthymiou¹, Gavin J Johnson¹, Marcello Maida², Paraskevas Gkolfakis^{3

4}, Daryl Ramai⁵, Antonio Facciorusso⁶, Marianna Arvanitakis⁴, Alexander Ney⁷, Giuseppe K Fusai⁸, Adrian Saftoiu⁹, Daniela Tabacelia⁹, Simon Phillpotts¹, Michael H Chapman¹, George J Webster¹, Stephen P Pereira^{1

7}

Affiliations

¹ Pancreaticobiliary Medicine Unit, University College London Hospitals (UCLH), London NW1 2BU, UK.
² Gastroenterology and Endoscopy Unit, S. Elia-Raimondi Hospital, 93100 Caltanissetta, Italy.
³ Department of Gastroenterology, General Hospital of Nea Ionia "Konstantopoulio-Patision", 14233 Athens, Greece.
⁴ Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, 1070 Brussels, Belgium.
⁵ Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, UT 84132, USA.
⁶ Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, 37920 Foggia, Italy.
⁷ Institute for Liver and Digestive Health, University College London, London NW3 2PF, UK.
⁸ Department of HPB Surgery and Liver Transplantation, Royal Free Hospital, London NW3 2QG, UK.
⁹ Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy "Carol Davila", 4192910 Bucharest, Romania.

Abstract

Background: Pancreatic cystic lesions (PCL) represent an increasingly diagnosed condition with significant burden to patients' lives and medical resources. Endoscopic ultrasound (EUS) ablation techniques have been utilized to treat focal pancreatic lesions. This systematic review with meta-analysis aims to assess the efficacy of EUS ablation on PCL in terms of complete or partial response and safety.

Methods: A systematic search in Medline, Cochrane and Scopus databases was performed in April 2023 for studies assessing the performance of the various EUS ablation techniques. The primary outcome was complete cyst resolution, defined as cyst disappearance in follow-up imaging. Secondary outcomes included partial resolution (reduction in PCL size), and adverse events rate. A subgroup analysis was planned to evaluate the impact of the available ablation techniques (ethanol, ethanol/paclitaxel, radiofrequency ablation (RFA), and lauromacrogol) on the results. Meta-analyses using a random effects model were conducted and the results were reported as percentages with 95% confidence intervals (95%CI).

Results: Fifteen studies (840 patients) were eligible for analysis. Complete cyst resolution after EUS ablation was achieved in 44% of cases (95%CI: 31-57; 352/767; I² = 93.7%), and the respective partial response rate was 30% (95%CI: 20-39; 206/767; I² = 86.1%). Adverse events were recorded in 14% (95%CI: 8-20; 164/840; I² = 87.2%) of cases, rated as mild in 10% (95%CI: 5-15; 128/840; I² = 86.7%), and severe in 4% (95%CI: 3-5; 36/840; I² = 0%). The subgroup analysis for the primary outcome revealed rates of 70% (95%CI: 64-76; I² = 42.3%) for ethanol/paclitaxel, 44% (95%CI: 33-54; I²= 0%) for lauromacrogol, 32% (95%CI: 27-36; I² = 88.4%) for ethanol, and 13% (95%CI: 4-22; I² = 95.8%) for RFA. Considering adverse events, the ethanol-based subgroup rated the highest percentage (16%; 95%CI: 13-20; I² = 91.0%).

Conclusion: EUS ablation of pancreatic cysts provides acceptable rates of complete resolution and a low incidence of severe adverse events, with chemoablative agents yielding higher performance rates.

Keywords: EUS; RFA; ablation; ethanol; lauromacrogol; paclitaxel; pancreatic cyst.

Publication types

Review

Grants and funding

S.P.P. is supported by the National Institute for Health and Care Research University College London Hospitals Biomedical Research Centre. This work was also supported by the European Research Executive Agency under the project Training in Translational Protocols for Minimally Invasive Diagnosis and Therapy In Pancreatico-Biliary Cancers—TRIP (grant agreement number: 101079210).