Comparison of efficacy and outcome of different management strategies for pancreatic pseudocysts in children: A systematic review and meta-analysis

INTRODUCTION: Pancreatic pseudocysts (PPC) are uncommon in children, and there is currently no consensus on their optimal management. This systematic review and meta-analysis aimed to evaluate the effectiveness and outcomes of different treatment approaches for pediatric PPCs. METHODS: A systematic literature search was performed in PubMed, EMBASE, and MEDLINE databases for studies published between January 2004 and December 2024, following the PRISMA guidelines and prospectively registered in PROSPERO (CRD42024608528). Eligible studies included pediatric patients (aged ≤18 years) diagnosed with PPCs, reporting clinical outcomes following either conservative management (CM) or interventional management (IM). Data about infection, recurrence, and the need for additional interventions were extracted. Meta-analysis was performed using the Comprehensive Meta-Analysis (CMA) software, with p < 0.05 considered significant. RESULTS: Eight studies encompassing 196 pediatric patients were included. Trauma was the most common etiology (52.6 %). Of the patients, 92 received CM and 104 received IM, including percutaneous external drainage and surgical or endoscopic techniques. Meta-analysis revealed no significant difference between CM and IM groups regarding recurrence (OR: 3.5; 95 % CI: 0.68-18.02; p = 0.133) or the need for additional interventions (OR: 1.62; 95 % CI: 0.62-4.22; p = 0.322). Infection rates were significantly higher in the IM group (OR: 6.67; 95 % CI: 1.08-40.97; p < 0.05). Subgroup analysis also demonstrated higher infection rates in percutaneous external drainage versus CM (OR: 8.26 (95 % CI: 1.33-51.08, p < 0.05). CONCLUSIONS: CM appears to be as effective as interventional approaches for pediatric PPCs in terms of recurrence and additional intervention needs, while being associated with a lower risk of infection. Non-invasive management should be considered as the first-line approach in clinically stable patients. LEVEL OF EVIDENCE: III. TYPE OF STUDY: Meta-analysis.