Introduction:

pancreatic pseudocysts are peri-pancreatic collections with a non-epithelial capsule that in case of not presenting spontaneous resolution needs intervention and drainage. Surgery and endoscopy have shown similar results in this task, however it is not clear which patients are better suited for each approach, therefore there is no management algorithm based on evidence.

Objective:

to know which procedure, surgery vs endoscopy, offers better results in drainage of pancreatic pseudocysts by mean of the evaluation of prognosis variables contained in the existent evidence that compares directly both techniques.

Material and methods:

systematized search was performed over internet databases, MedLine Via PubMed, SCOPUS, LILACS, Trip DATABASE and in use of metadata and cross references with REFSEEK and CROSSREF looking for clinical trials and Cohort Studies published in a period of 10 years where the endoscopic and surgical intervention were compared, two independent researchers analyzed and compared the information which was audited by a moderator. Systematic review and meta-analysis was performed.

Results:

up to 6 studies were conducted into qualitative and quantitative analysis, with a total of 347 patients, 187 with endoscopic management and 160 with surgical management, the therapeutic success was presented in 95.1% (91.1 to 97.7) of the patients managed with surgery and 87.8% (82.2 to 92.1) of the patients managed with endoscopy, with an OR of 2.41 (95% CI 1.08 to 5.38) in favor of surgical management with statistical significance (p = 0.03) (heterogeneity I(2) 0.0% p = 0.86). 18.3% (13.1 to 24.5) in the surgical group presented adverse events, only 15.1% (10.3 to 21.1) of the managed endoscopically, with an OR 0.90 (95% CI 0.51 to 1.58) (heterogeneity I(2) 12% p = 0.34) with no statistical significance. 6.07% in the group of surgery shown recurrence, 8.12% shown this characteristic in the endoscopy group with an OR of 1.54 (95% CI 0.48 to 4.98) (heterogeneity I(2) 29% p = 0.24) without statistical significance (p = 0.47).

Conclusions:

surgical techniques are superior to endoscopic ones in terms of therapeutic success, no statistical difference where identified in recurrence and adverse events. The arrival of emergent techniques like Hybrid NOTES and the Luminal apposition stents have shown characteristics that could resolve the problems presented by current techniques. However it is still necessary better evidence that permits clinical stratification based on anatomical characteristics, risk of recurrence and complications that provide the physician the needed tools for choosing which patients are better suited for each approach.

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