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Meta-Analysis
. 2017 Mar 20;12(3):e0173687.
doi: 10.1371/journal.pone.0173687. eCollection 2017.

The incremental benefit of EUS for identifying unresectable disease among adults with pancreatic adenocarcinoma: A meta-analysis

Paul D James  1   2   3   4 , Zhao Wu Meng  1 , Mei Zhang  2 , Paul J Belletrutti  2   3   4 , Rachid Mohamed  2   3   4 , William Ghali  2   3 , Derek J Roberts  5 , Guillaume Martel  6 , Steven J Heitman  2   3   4
Affiliations
Meta-Analysis

The incremental benefit of EUS for identifying unresectable disease among adults with pancreatic adenocarcinoma: A meta-analysis

Paul D James et al. PLoS One. .

Abstract

Background and study aims: It is unclear to what extent EUS influences the surgical management of patients with pancreatic adenocarcinoma. This systematic review sought to determine if EUS evaluation improves the identification of unresectable disease among adults with pancreatic adenocarcinoma.

Patients and methods: We searched MEDLINE, EMBASE, bibliographies of included articles and conference proceedings for studies reporting original data regarding surgical management and/or survival among patients with pancreatic adenocarcinoma, from inception to January 7th 2017. Our main outcome was the incremental benefit of EUS for the identification of unresectable disease (IBEUS). The pooled IBEUS were calculated using random effects models. Heterogeneity was explored using stratified meta-analysis and meta-regression.

Results: Among 4,903 citations identified, we included 8 cohort studies (study periods from 1992 to 2007) that examined the identification of unresectable disease (n = 795). Random effects meta-analysis suggested that EUS alone identified unresectable disease in 19% of patients (95% confidence interval [CI], 10-33%). Among those studies that considered portal or mesenteric vein invasion as potentially resectable, EUS alone was able to identify unresectable disease in 14% of patients (95% CI 8-24%) after a CT scan was performed.

Limitations: The majority of the included studies were retrospective.

Conclusions: EUS evaluation is associated with increased identification of unresectable disease among adults with pancreatic adenocarcinoma.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Algorithm applied to calculate the incremental benefit of endoscopic ultrasound (IBEUS) for the identification of unresectable disease among patients with pancreatic adenocarcinoma.
Fig 2
Fig 2. PRISMA flow-chart of included studies for meta-analysis.
Fig 3
Fig 3. The incremental benefit of endoscopic ultrasound for the identification of unresectable disease.
IBEUS = Incremental benefit of endoscopic ultrasound; CI = Confidence interval; EUS = Endoscopic ultrasound; I2 = 84.8%, P<0.0001
See this image and copyright information in PMC

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