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


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.


CONCLUSIONS
The majority of the included studies were retrospective.


CONCLUSIONS
EUS evaluation is associated with increased identification of unresectable disease among adults with pancreatic adenocarcinoma.
Department of Medicine and the Ottawa Hospital Research Institute, Department of Medicine, University of Ottawa, Ottawa, Canada.|Department of Community Health Sciences, University of Calgary, Calgary, Canada.|Department of Medicine, University of Calgary, Calgary, Canada.|Calgary Research and Education in Advanced Therapeutic Endoscopy (CREATE), Calgary, Canada.
Paul D
PD
James
Department of Medicine and the Ottawa Hospital Research Institute, Department of Medicine, University of Ottawa, Ottawa, Canada.
Zhao Wu
http://orcid.org/0000-0003-3589-2208
ZW
Meng
Department of Community Health Sciences, University of Calgary, Calgary, Canada.
Mei
M
Zhang
Department of Community Health Sciences, University of Calgary, Calgary, Canada.|Department of Medicine, University of Calgary, Calgary, Canada.|Calgary Research and Education in Advanced Therapeutic Endoscopy (CREATE), Calgary, Canada.
Paul J
PJ
Belletrutti
Department of Community Health Sciences, University of Calgary, Calgary, Canada.|Department of Medicine, University of Calgary, Calgary, Canada.|Calgary Research and Education in Advanced Therapeutic Endoscopy (CREATE), Calgary, Canada.
Rachid
R
Mohamed
Department of Community Health Sciences, University of Calgary, Calgary, Canada.|Department of Medicine, University of Calgary, Calgary, Canada.
William
W
Ghali
Department of Surgery, University of Calgary, Calgary, Canada.
Derek J
DJ
Roberts
Department of Surgery, University of Ottawa, Ottawa, Canada.
Guillaume
G
Martel
Department of Community Health Sciences, University of Calgary, Calgary, Canada.|Department of Medicine, University of Calgary, Calgary, Canada.|Calgary Research and Education in Advanced Therapeutic Endoscopy (CREATE), Calgary, Canada.
Steven J
SJ
Heitman
D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000601:surgery; D000328:Adult; D019160:Endosonography / Q000379:methods*; D006801:Humans; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery