Safety and efficacy of EUS-guided ablation of pancreatic lesions with ethanol versus ethanol with paclitaxel: A systematic review and meta-analysis Saghir SM, Dhindsa BS, Daid SG, Naga Y, Dhaliwal A, Mashiana HS, Bhogal N, Sayles H, Ramai D, Singh S, Bhat I, Rangray R, McDonough S, Adler DG,

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Safety and efficacy of EUS-guided ablation of pancreatic lesions with ethanol versus ethanol with paclitaxel: A systematic review and meta-analysis Syed Mohsin Saghir¹, Banreet Singh Dhindsa², Sarav Gunjit Singh Daid³, Yassin Naga¹, Amaninder Dhaliwal⁴, Harmeet S Mashiana², Neil Bhogal², Harlan Sayles⁵, Daryl Ramai⁶, Shailender Singh², Ishfaq Bhat², Rajani Rangray⁷, Stephanie McDonough⁸, Douglas G Adler⁹ ¹ Department of Internal Medicine, University of Nevada Las Vegas School of Medicine, Las Vegas, Nevada, USA ² Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Nebraska Medical Center, Omaha, NE, USA ³ Department of Internal Medicine, New York Medical College, NYC Health + Hospitals/Metropolitan, New York, NY, USA ⁴ Division of Gastroenterology and Hepatology, Moffitt Cancer Center, Tampa, FL, USA ⁵ Department of Biostatistics, University of Nebraska Medical Center, Nebraska Medical Center, Omaha, NE, USA ⁶ Department of Internal Medicine, The Brooklyn Hospital Center, Brooklyn, New York, USA ⁷ Division of Gastroenterology and Hepatology, CHI Health Creighton University Medical Center, Omaha, NE, USA ⁸ Division of Gastroenterology and Hepatology, University of Utah, Salt Lake City, Utah, USA ⁹ Center for Advanced Therapeutic Endoscopy (CATE), Centura Health, Porter Hospital, Peak Gastroenterology, Denver, Colorado, USA Correspondence Address: Douglas G Adler, Porter Adventist Hospital 2525 S Downing St, Denver, CO 80210 USA Source of Support: None, Conflict of Interest: None DOI: 10.4103/EUS-D-20-00185

Background and Objectives: EUS-guided ethanol ablation has emerged as an alternative method for pancreatic lesions. Recently, paclitaxel was added to ethanol to assess ablative effects in pancreatic lesions. We performed a systematic review and meta-analysis on EUS-guided ethanol ablation (EUS E) versus EUS-guided ethanol with paclitaxel (EUS EP) ablation for the management of pancreatic lesions. Methods: Comprehensive search of multiple electronic databases and conference proceedings including PubMed, EMBASE, Google Scholar, and Web of Science databases (from inception to May 2020). The primary outcome evaluated complete ablation of the lesions radiologically and the secondary outcome evaluated adverse events (AEs). Results: Fifteen studies on 524 patients were included in our analysis. The pooled complete ablation rate was 58.89% (95% confidence interval (CI) = 38.72–77.80, I² = 91.76%) and 55.99% (95% CI = 44.66–67.05, I² = 0) in the EUS E and EUS EP groups (P = 0.796), respectively. The pooled AE rates were 13.92% (95% CI = 4.71–26.01, I² = 83.43%) and 31.62% (95% CI = 3.36–68.95, I² = 87.9%) in the EUS E and EUS EP groups (P = 0.299), respectively. The most common AE was abdominal pain at 7.27% (95% CI = 1.97–14.6, I² = 68.2%) and 12.44% (95% CI = 0.00–39.24, I² = 81.1%) in the EUS E and EUS EP groups (P = 0.583), respectively. Correlation coefficient (r) was ‒0.719 (P = 0.008) between complete ablation and lesion size. Conclusion: Complete ablation rates were comparable among both groups. AE rates were higher in the EUS EP group. Further randomized controlled trials are needed to validate our findings.

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    -  Saghir SM
    -  Dhindsa BS
    -  Daid SG
    -  Naga Y
    -  Dhaliwal A
    -  Mashiana HS
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    -  Sayles H
    -  Ramai D
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