Systematic Reviews
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jul 16, 2022; 14(7): 443-454
Published online Jul 16, 2022. doi: 10.4253/wjge.v14.i7.443
Quality of life after surgical and endoscopic management of severe acute pancreatitis: A systematic review
Emmanouil Psaltis, Chris Varghese, Sanjay Pandanaboyana, Manu Nayar
Emmanouil Psaltis, Sanjay Pandanaboyana, Department of HPB and Transplant Surgery, Newcastle upon Tyne NE7 7DN, United Kingdom
Emmanouil Psaltis, Sanjay Pandanaboyana, Department of Surgery, Freeman Hospital, Newcastle upon Tyne NE7 7DN, United Kingdom
Chris Varghese, Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1010, New Zealand
Sanjay Pandanaboyana, Manu Nayar, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, United Kingdom
Manu Nayar, Department of Gastroenterology, Freeman Hospital, Newcastle upon Tyne NE7 7DN, United Kingdom
Author contributions: Psaltis E, Varghese C, Pandanaboyana S and Nayar M designed the research study; Psaltis E and Varghese C performed the research; Psaltis E and Varghese C analyzed the data and wrote the manuscript; Pandanaboyana S and Nayar M had the overall supervision of the study; all authors have read and approved the final manuscript.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Manu Nayar, MBBS, MD, MRCP, Consultant Physician-Scientist, Doctor, Department of Gastroenterology, Freeman Hospital, Freeman Road, High Heaton, Newcastle Upon Tyne NE7 7DN, United Kingdom.
Received: January 27, 2022
Peer-review started: January 27, 2022
First decision: April 10, 2022
Revised: May 3, 2022
Accepted: June 20, 2022
Article in press: June 20, 2022
Published online: July 16, 2022
Research background

Treatment for severe acute pancreatitis (SAP) can significantly affect health related quality of life (HR-QoL). However, the effects of different treatment strategies such as surgical, minimally invasive or endoscopic necrosectomy, on HR-QoL remain poorly investigated. Therefore, there is no evidence to favor any of the existing approaches as the better treatment of SAP in terms of quality of life. To the best of our knowledge this is the first systematic review to assess HR-QoL following pancreatic necrosectomy in patients with SAP.

Research motivation

Traditionally, open necrosectomy has been the standard approach for patients with SAP and necrosis of pancreatic parenchyma. This was followed by the introduction of surgical step up-approach combined with minimally invasive necrosectomy as the treatment of choice. More recently, endoscopic necrosectomy has gained popularity as it offers significantly lower morbidity and mortality rates. However, in the era of patient-centered medicine, HR-QoL also needs to be considered. Unfortunately, there is no clear evidence to favor any of these procedures as the better treatment of SAP in terms of quality of life.

Research objectives

The objective of this study was to critically appraise the published evidence on HR-QoL in patients with SAP who underwent surgical or endoscopic necrosectomy.

Research methods

A literature search was performed on several databases for studies that examined the HR-QOL following necrosectomy in adult patients with SAP. Studies published in English were excluded due to limited resources. Data were collected on the details of each study, patient characteristics as well as HR-QoL. The Cochrane risk of bias tool for randomized control trials (RoB 2.0) was used to assess bias in the included randomized studies whereas the Risk of Bias In Non-randomized Studies – of Interventions (ROBINS-I) was used to asses bias in the included observational studies.

Research results

Eleven studies evaluated HR-QoL following necrosectomy including 756 patients. Three studies were randomized trials and eight were cohort studies. One randomized trial and one cohort study demonstrated significantly improved physical scores at three months in patients who underwent endoscopic necrosectomy compared to surgical necrosectomy. In the only study that examined patients following endoscopic necrosectomy, the HR-QoL was also very good. Two randomized trials and one cohort study investigated the quality adjusted life years suggesting that endoscopic and surgical necrosectomy were comparable in cost effectiveness. When open necrosectomy was compared with minimally invasive approaches, patients who underwent the later reported better overall quality of life, vitality and mental health.

Research conclusions

This study would suggest that the endoscopic approach should be the preferred method for pancreatic necrosectomy as it might offer better HR-QoL. However, more randomized trials powered to detect differences in HR-QoL are still required.

Research perspectives

Future research should aim to provide the tools for a person-centered coordinated care through a patient reported experience and outcome measures. This will improve results, adherence, patient satisfaction and quality of life. It is also important to create a disease specific HR-QoL questionnaire for acute pancreatitis to allow evaluation of different management strategies and the impact they have on HR-QoL.