Mo1152 COMPARING MORTALITY AND MAJOR COMPLICATIONS WITH ENDOSCOPIC DRAINAGE VS PERCUTANEOUS DRAINAGE IN PATIENTS WITH ACUTE INFECTED NECROTIZING PANCREATITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Acute pancreatitis can lead to necrosis of the pancreatic parenchyma. Infected necrotizing pancreatitis requires debridement, which traditionally has been performed with the surgical step-up approach, which includes percutaneous drainage, followed by open surgery if needed. Endoscopic catheter drainage in evolving as a promising alternative treatment option. This is a meta-analysis to pool the evidence for endoscopic (E group) versus percutaneous drainage (P group) in managing acute infected necrotizing pancreatitis patients. The primary outcome was to compare the mortality and major complications in the treatment groups. Study Selection Criteria: Prospective, retrospective and randomized control trials comparing Endoscopic drainage and percutaneous drainage in the patients with Acute Necrotizing Pancreatitis were included in the analysis. Data collection and extraction: Articles were searched in Pubmed, Ovid journals, Medline, Google Scholar, Cochrane Central Register for Controlled trials & Database of Systematic Review. Two reviewers independently searched and extracted data. Any differences were resolved with mutual agreement. Pooled proportions were calculated using both Mantel-Haenszel method (fixed effects model). The heterogeneity among studies was tested using Cochran’s Q test based upon inverse variance weights. Initial search identified 486 reference articles, of which 23 articles were selected and reviewed. Three studies (N=184) were selected which met the inclusion criteria were included in the analysis. Median age of the patients was 62 years, predominantly male population (64%). P for chi-squared heterogeneity for all the pooled accuracy estimates was >0.10. Pooled odds ratio by fixed effects comparing mortality and major complications in endoscopic versus percutaneous group was 0.89 (95% CI = 0.35 to 2.20). Pooled odds ratio by fixed effects comparing major complications in E group versus P group was 0.97 (95% CI = 0.48 to 1.94). Publication bias calculated using Harbord-Egger: bias gave a value of -2.12 (92.5% CI = -9.96 to 5.73) P = 0.26. The mortality and major complication rates seem to be similar in endoscopic catheter drainage group and percutaneous catheter drainage group for treating acute infected necrotizing pancreatitis.