Are Non-Ethanol Based Ablation Therapies Better Than Ethanol Ablation for Pancreatic Cysts?: A Systematic Review and Meta-Analysis: Research Article

Yeshaswini Reddy; Tulika Chatterjee; Srinivas Puli

doi:10.58372/2835-6276.1194

Authors

Yeshaswini Reddy
Tulika Chatterjee
Srinivas Puli

DOI:

https://doi.org/10.58372/2835-6276.1194

Keywords:

Endoscopic ultrasound of pancreas, ethanol ablation, pancreatic cysts, pancreatic cyst ablation, paclitaxel ablation, endoscopic ablation therapy

Abstract

Background: Endoscopic Ultrasound (EUS) guided Ethanol Ablation of the pancreatic cyst has been used as an alternative for surgery in recent years. In this meta-analysis, we compare the outcomes of pancreatic cyst ablation with ethanol-based ablation therapy versus non-ethanol-based ablation therapies.

Methods: Selection Criteria included pancreatic cyst ablations with EUS-guided ethanol and non-ethanol ablation. Data was collected and extracted from Medline, Pubmed, and Ovid journals. Statistical analysis used Fixed and random effects models to calculate the pooled proportions.

Results: Upon initial search, 1,510 articles were found, out of which 131 articles were selected and reviewed. Data was extracted from nineteen studies (n=609) which looked at EUS-guided ablation of pancreatic cysts that met the inclusion criteria. Of the nineteen studies, eight (n=390) used EUS-guided ethanol ablation. Four (n=88) studies used ethanol with a paclitaxel combination for ablation, and seven (n=131) used non-ethanol-based ablations alone. The non-ethanol-based ablations included Paclitaxel, Paclitaxel, Gemcitabine combination, or Lauromacrogol. The pooled proportion of patients with complete cyst resolution in the ethanol group was 61.11% (95% CI = 56.25 to 65.86), ethanol with paclitaxel group was 54.34% (95% CI = 44.03 to 64.46), and the non-ethanol group was 49.59 % (95% CI = 41.19 to 58.01). Patients with partial cyst resolution had a pooled proportion of 7.41% (95% CI = 5.03 to 10.2) in the ethanol group, 27.45% (95% CI = 18.77 to 37.08) in the ethanol with paclitaxel group, and 29.16% (95% CI = 21.82 to 37.11) in the non-ethanol group. The pooled proportion of patients with persistent cysts was 45.57% (95% CI = 43.87 to 47.28) in the ethanol group, 6.93% (95% CI = 2.63 to 13.05) in the ethanol with paclitaxel group, and 21.17% (95% CI = 14.71 to 28.45) in the non-ethanol group. Procedure-related complications, including pancreatitis, were noted in a pooled proportion of 8.08% (95% CI = 5.51 to 11.11) in the ethanol group, which was relatively higher compared to 5.82% (95% CI = 1.95 to 11.56) in the ethanol with paclitaxel group, and 3.91% (95% CI = 1.31 to 7.83) in the non-ethanol group. Other complications included post-procedure infection with a pooled proportion of 1.13% (95% CI = 0.3 to 2.47) in the ethanol group, 2.84% (95% CI = 0.43 to 7.26) in the ethanol with paclitaxel group, and 1.87% (95% CI = 0.27 to 4.83) in the non-ethanol group. The pooled proportion of patients who had procedure-related abdominal pain was 19.06% (95% CI = 15.18 to 23.25) in the ethanol group, which was significantly higher when compared to ethanol with paclitaxel group which was 9.58% (95% CI = 4.4 to 16.48), and 9.11% (95% CI = 4.85 to 14.53) in the non-ethanol group. Publication bias calculated using the Harbord-Egger bias indicator gave a value of 2.3 (p = 0.09). The Begg-Mazumdar indicator gave Kendall's tau b value of 0.28 (p = 0.39).

Conclusions: EUS-guided pancreatic cyst ablation is an alternative therapy for non-surgical candidates. This study showed that complete cyst resolution was comparable in patients with ethanol and non-ethanol ablation. Procedural adverse events were minimal in all the treatment groups, suggesting that pancreatic cyst ablation is safe.

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