Vol.:(0123456789) 1 3 Digestive Diseases and Sciences https://doi.org/10.1007/s10620-021-07035-w ORIGINAL ARTICLE Intracystic Glucose Levels Appear Useful for Diagnosis of Pancreatic Cystic Lesions: A Systematic Review and Meta‑Analysis Edson Guzmán‑Calderón 1,2,4  · Belen Martinez‑Moreno MD 3  · Juan A. Casellas 3  · José Ramón Aparicio 3 Received: 22 January 2021 / Accepted: 4 May 2021 © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2021 Abstract Background Carcinoembryonic antigen (CEA) in the pancreatic cystic fluid is the most important biomarker for differentiat- ing mucinous from non-mucinous pancreatic cystic lesions (PCLs). However, recent studies have shown that glucose levels in pancreatic cystic fluid can discriminate mucinous from non-mucinous cysts. Aims To perform a meta-analysis to determine the utility of intracystic fluid glucose of pancreatic mucinous cysts compared with intracystic CEA. Methods We conducted a systematic review of the literature in the PubMed, OVID Medline, and Cochrane databases. This meta-analysis considers studies published up to October 2020. Results Six studies comprising 506 patients were selected; 61.2% of the population was female. Of the 480 PCLs, 287 (59.7%) were mucinous. Pooled sensitivity and specificity of cystic fluid glucose levels for mucinous PCLs were 91% and 85%, respectively. The positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were 6.33 and 0.11, respectively. Pooled diagnostic odds ratio (DOR) was 60.94. The pooled area under the summary receiver operating characteristic (SROC) curve was 0.959. Pooled sensitivity and specificity of pancreatic cystic fluid CEA levels were 61% and 93%. The PLR and NLR were 8.51 and 0.40, respectively. Pooled DOR was 23.52, and the pooled area under the SROC curve was 0.861. Conclusion Glucose has become a useful method and appears to be better than CEA for differentiating between mucinous PCLs and non-mucinous PCLs. We suggest that the analysis of glucose in PCLs be routinely performed for the differential diagnosis of these lesions. Keywords Glucose · Carcinoembryonic antigen · Cystic fluids · Pancreatic cystic lesions Introduction Pancreatic cystic lesions (PCL) are a heterogeneous group of pancreatic lesions that occur with significant frequency. There are different ways of classifying pancreatic cysts. The most widely accepted classification divides them into two groups: mucinous and non-mucinous. The first group includes mucinous cystic neoplasm (MCN) and intraductal papillary mucinous neoplasms (IPMN), whereas the second group includes serous cystic neoplasms (SCN), cystic neu- roendocrine tumors (CNT), pancreatic pseudocysts, solid pseudopapillary tumors, and cystic pancreatic adenocarci- nomas [1–3]. PCLs have diverse clinical, pathological, and radiological features. Studies have shown that the presence of PCLs is found incidentally in 3–14% of patients who undergo imaging tests [4, 5]. The most prevalent premalig- nant lesions are mucinous cysts, but their malignant poten- tial is still uncertain; this can raise concerns regarding the prognosis for both the doctor and the patient [6, 7]. PCLs can be precursors of pancreatic cancer, and in many cases the differential diagnosis is difficult. In some studies, the malignant potential of PCLs reaches 10% of non-invasive carcinomas and 13% of invasive carcinomas [8]. Endoscopic ultrasound with fine-needle aspiration (EUS- FNA) is currently the best tool for characterizing PCLs [9]. * Edson Guzmán-Calderón edson_guzman@hotmail.com 1 Gastroenterology Unit of Hospital Nacional Edgardo Rebagliati Martins, Av. Edgardo Rebagliati s/n, Jesús María, Lima, Peru 2 Universidad Peruana de Ciencias Aplicadas (UPC), Lima, Peru 3 Gastroenterology Unit Oh Hospital General Universitario de Alicante, Alicante, Spain 4 Gastroenterology Unit of Angloamericana Clinic, Lima, Peru