Endoscopic ultrasound-guided ethanol vs ethanol combined with paclitaxel for the ablation of pancreatic cystic lesions: a systematic review and meta-analysis

Abstract

Background

Some pancreatic cystic lesions (PCLs) have the risk of malignant transformation, but the complications of pancreatic surgery are high, and minimally invasive treatment is imperative. Endoscopic ultrasound (EUS) -guided ablation has been utilized to treat pancreatic cysts. We undertook the meta-analysis and systematic review to assess the efficacy and safety of this technique in PCLs.

Methods

MEDLINE, Embase, Cochrane Library databases were searched for relevant studies reporting on EUS-guided ablation on PCLs with outcomes of interest. The primary outcome was complete cyst resolution rate, and secondary outcome was adverse events rate.

Results

Eleven studies (1092 patients with 1093 PCLs) were selected. Pooled complete cyst resolution rate was 52.6% (95%CI: 41.1–64.1%; I² = 89.3%). Pooled adverse events rate was 17.8% (95%CI: 9.7–27.7%; I² = 88.4%). Subgroup analysis showed that the complete cyst resolution rates were higher in ethanol-sequenced paclitaxel subgroup compared to ethanol subgroup (65.9% vs. 46.5%, P = 0.105). Considering adverse events, the subgroup analysis for the adverse events showed the rates were reduced in ethanol-sequenced paclitaxel compared to ethanol (11.9% vs. 15.9%, p = 0.484).

Conclusions

EUS-guided ablation appears to be a minimally invasive treatment with an acceptable efficacy and safety. Ethanol-sequenced paclitaxel is superior to ethanol alone in terms of efficacy and safety for PCLs ablation, but there is no statistical difference; more perfect studies are needed to verify these in the future.

PROSPERO registration number

CRD42024583031.