731 Endoscopic Ultrasound-Guided Gallbladder Drainage (Eus-Gb) Compared to Percutaneous Gallbladder Drainage (Pc-Gb) for High-Risk Non-Surgical Patients With Acute Cholecystitis: A Large Academic Tertiary Care Center Experience

Abstract

Background and Aim: Walled off pancreatic necrosis (WON) is an important complication of acute necrotizing pancreatitis (ANP). There are limited data on comparison of nasocystic irrigation versus lumen apposing metal stent (LAMS) in management of WON. We compare the technical and clinical success of both the treatment strategies. Material and Methods: A randomized controlled trial conducted on patients with ANP with symptomatic WON who were randomized to nasocystic irrigation with hydrogen peroxide (group A) and LAMS placement (group B). ANP was diagnosed based on clinical features, laboratory parameters and imaging. Primary end points were clinical and technical success of both the procedures. Results: 47 patients were randomized till date to group A (nZ24, age 37.8AE27.4 years, 15 men) and group B (nZ23, age 40.9AE20.6 years, 17 men). There were no significant difference in baseline characteristics between the two groups. Most common etiology was alcohol observed in 27(57.4%) patients and most common symptom was abdominal pain seen in all patients. Technical success (100% vs 91.4%, pZ0.95) and clinical success (83.33% vs 78.3%, p Z0.9), additional procedures to get clinical success (15% vs 21.66%, pZ0.9) and complications (4 vs 5, pZ0.9) were comparable in both the groups. The duration to get clinical success (35.5AE49.1 days vs 14.9 AE24.8 days, p Z0.004) was longer in group A compared to group B. Conclusions: LAMS and nasocystic irrigation with H 2 O 2 are equally effective in the treatment of WON but duration of clinical success is longer with nasocystic irrigation.

Endoscopic Ultrasound-Guided Gallbladder Drainage versus Percutaneous Gallbladder Drainage for Acute Cholecystitis: A Systematic Review and Meta-Analysis

“…Screening the titles and abstracts yielded 27 studies for detailed review. Ultimately, we found 11 eligible studies based on inclusion and exclusion criteria [5][6][7][12][13][14][15][16][17][18][19]. Figure 1 illustrates the flow chart for the literature search and study selection.…”

“…Figure 1 illustrates the flow chart for the literature search and study selection. Among the 11 studies included in the meta-analysis, there were 8 retrospective studies [5,7,[12][13][14][16][17][18], one of them being a propensity-matched cohort study [19] and 3 prospective studies (One prospective cohort study and two randomized controlled trials) [6,15,19]. Seven of the 11 studies were full-length articles [5][6][7]15,16,18,19] and the remaining 4 studies were published as abstracts; however, the data on outcomes were reported [12][13][14]17].…”

“…Among the 11 studies included in the meta-analysis, there were 8 retrospective studies [5,7,[12][13][14][16][17][18], one of them being a propensity-matched cohort study [19] and 3 prospective studies (One prospective cohort study and two randomized controlled trials) [6,15,19]. Seven of the 11 studies were full-length articles [5][6][7]15,16,18,19] and the remaining 4 studies were published as abstracts; however, the data on outcomes were reported [12][13][14]17]. Four studies originated from the USA [13,16,17,20], two studies originated from Korea [14,15], one study from Italy [12] and Japan [19] each, and the remaining three studies were multi-center studies from more than one country [5,6,19].…”

“…Seven of the 11 studies were full-length articles [5][6][7]15,16,18,19] and the remaining 4 studies were published as abstracts; however, the data on outcomes were reported [12][13][14]17]. Four studies originated from the USA [13,16,17,20], two studies originated from Korea [14,15], one study from Italy [12] and Japan [19] each, and the remaining three studies were multi-center studies from more than one country [5,6,19]. Table 1 contains the characteristics of the studies included in this meta-analysis.…”