Hydrogen peroxide–assisted endoscopic necrosectomy of pancreatic walled-off necrosis: a systematic review and meta-analysis

Background and Aims: Use of hydrogen peroxide (H₂O₂) has been reported in direct endoscopic necrosectomy (DEN) of pancreatic walled-off necrosis (WON). The aim of this meta-analysis was to study the pooled clinical outcomes of H₂O₂-assisted DEN of pancreatic WON. Methods: We conducted a comprehensive search of several databases (inception to July 2021) to identify studies reporting on the use of H₂O₂ in DEN of WON. A random-effects model was used to calculate pooled rates and I² values, and 95% prediction intervals were used to assess heterogeneity. The outcomes studied were technical success, clinical success, and adverse events in H₂O₂-assisted DEN of pancreatic WON. Results: In 7 analyzed studies, 186 patients underwent H₂O₂-assisted DEN of WON. The pooled rate of technical success was 95.8% (95% confidence interval [CI], 88.5-98.5), clinical success was 91.6% (95% CI, 86.1-95), and cumulative rate of overall adverse events was 19.3% (95% CI, 7.6-41). The pooled rate of bleeding was 7.9% (95% CI, 2.4-22.7), stent migration was 11.3% (95% CI, 4.9-23.9), perforation 5.4% (95% CI, 1.7-15.7), infection 5.7% (95% CI, 2-15.1), and pulmonary adverse event 2.9% (95% CI, 1.3-6.1). Mean treatment sessions ranged from 2 to 5. Conclusions: H₂O₂-assisted DEN of WON demonstrated excellent clinical outcomes, with minimal heterogeneity. No adverse events attributable to H₂O₂ were reported. Future controlled studies are warranted comparing the clinical outcomes with and without H₂O₂ before H₂O₂ use can be established in DEN of pancreatic WON.