Background: Use of hydrogen peroxide (H2O2) has been reported in the direct endoscopic necrosectomy (DEN) of pancreatic walled-off necrosis (WON). The aim of this meta-analysis was to study the pooled clinical outcomes of H2O2-assisted DEN of pancreatic WON. Methods: We conducted a comprehensive search of several databases (inception to July 2021) to identify studies reporting on the use of H2O2 in DEN of WON. Random effects model was used to calculate the pooled rates and I2% values, 95% prediction intervals were used to assess the heterogeneity. The outcomes studied were technical success, clinical success, and adverse events in H2O2-assisted DEN of pancreatic WON. Results: 7-studies were analyzed, in which a total of 186 patients underwent H2O2-assisted DEN of WON. The pooled rate of technical success was 95.8% (95% CI 88.5-98.5), the clinical success was 91.6% (95% CI 86.1-95), and the cumulative rate of overall adverse events was 19.3% (95% CI 7.6-41). The pooled rate of bleeding was 7.9% (95% CI 2.4-22.7), stent migration was 11.3% (95% CI 4.9-23.9), perforation was 5.4% (95% CI 1.7-15.7), infection was 5.7% (95% CI 2-15.1), and pulmonary complication was 2.9% (95% CI 1.3-6.1). Mean treatment sessions ranged from 2 to 5. Conclusion: H2O2-assisted DEN of WON demonstrated excellent clinical outcomes, with minimal heterogeneity. No adverse events attributable to H2O2 were reported. Future controlled studies are warranted comparing the clinical outcomes with and without H2O2 before H2O2 use can be established in the DEN of pancreatic WON.
Hydrogen Peroxide Assisted Endoscopic Necrosectomy of Pancreatic Walled-Off Necrosis: A Systematic Review and Meta-Analysis
Facciorusso, Antonio;
2022-01-01
Abstract
Background: Use of hydrogen peroxide (H2O2) has been reported in the direct endoscopic necrosectomy (DEN) of pancreatic walled-off necrosis (WON). The aim of this meta-analysis was to study the pooled clinical outcomes of H2O2-assisted DEN of pancreatic WON. Methods: We conducted a comprehensive search of several databases (inception to July 2021) to identify studies reporting on the use of H2O2 in DEN of WON. Random effects model was used to calculate the pooled rates and I2% values, 95% prediction intervals were used to assess the heterogeneity. The outcomes studied were technical success, clinical success, and adverse events in H2O2-assisted DEN of pancreatic WON. Results: 7-studies were analyzed, in which a total of 186 patients underwent H2O2-assisted DEN of WON. The pooled rate of technical success was 95.8% (95% CI 88.5-98.5), the clinical success was 91.6% (95% CI 86.1-95), and the cumulative rate of overall adverse events was 19.3% (95% CI 7.6-41). The pooled rate of bleeding was 7.9% (95% CI 2.4-22.7), stent migration was 11.3% (95% CI 4.9-23.9), perforation was 5.4% (95% CI 1.7-15.7), infection was 5.7% (95% CI 2-15.1), and pulmonary complication was 2.9% (95% CI 1.3-6.1). Mean treatment sessions ranged from 2 to 5. Conclusion: H2O2-assisted DEN of WON demonstrated excellent clinical outcomes, with minimal heterogeneity. No adverse events attributable to H2O2 were reported. Future controlled studies are warranted comparing the clinical outcomes with and without H2O2 before H2O2 use can be established in the DEN of pancreatic WON.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
