Long-Term Outcomes of Endoscopic Ultrasound–Guided Ablation Vs Surgery for Pancreatic Cystic Tumors

Background and Aims Endoscopic ultrasound-guided pancreatic cyst ablation (EUS-PCA) is performed as an alternative to surgical resection in selected patients with pancreatic cystic tumors (PCTs). However, no studies have been conducted to compare outcomes between EUS-PCA and surgery for PCTs. Methods We reviewed a PCT database to identify patients with unilocular or oligolocular PCTs who underwent EUS-PCA or surgery between January 2004 and July 2019. We performed 1:1 propensity score matching based on potential confounding factors. The primary outcome was long-term morbidities. Secondary outcomes included early (≤14 days) and late (>14 days) major adverse events (MAEs), development of diabetes mellitus (DM), readmission, length of hospital stay, and therapeutic efficacy. Results A total of 620 patients (EUS-PCA, n = 310; surgery, n = 310) were selected after propensity score matching. The EUS-PCA group showed a lower 10-year rate of cumulative long-term morbidities (1.6% vs. 33.5%; P = .001) as well as lower rates of early MAE (1.0% vs. 8.7%; P = .001), late MAE (0.3% vs. 5.5%; P = .001), and readmission (1.0% vs. 15.2%; P = .001). The EUS-PCA group had a shorter hospital stay (3.5 vs. 10.3 days; P = .001) and a lower incidence of DM (2.2% vs. 22.8%; P = .001), while the surgery group had higher complete resolution rate (76.5% vs. 100%; P = .001) and lower relapse rate (4.6% vs. 0.3%; P = .001). Conclusions For select patients with PCTs, EUS-PCA showed superior results to surgery in terms of long-term safety profile and preservation of pancreatic function.