Endoscopic ultrasound-guided gallbladder drainage versus percutaneous cholecystostomy for high risk surgical patients with acute cholecystitis: a systematic review and meta-analysis

Abstract

Background Recent evidence suggests that endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is an effective and safe alternative to percutaneous drainage (PT-GBD). We conducted a systematic review and meta-analysis to compare these two procedures in high risk surgical patients with acute cholecystitis. Methods A comprehensive electronic literature search was conducted for all articles published up to October 2017 to identify comparative studies between EUS-GBD and PT-GBD. A meta-analysis was performed on outcomes including technical success, clinical success, post-procedure adverse events, length of hospital stay, unplanned hospital readmission, need for reintervention, recurrent cholecystitis, and disease- or treatment-related mortality for these two procedures. Results Five comparative studies (206 patients in the EUS-GBD group vs. 289 patients in the PT-GBD group), were included in the final analysis. There were no statistically significant differences in technical success (odds ratio [OR] 0.43, 95 % confidence interval [CI] 0.12 to 1.58; P = 0.21; I 2 = 0 %) and clinical success (OR 1.07, 95 %CI 0.36 to 3.16; P = 0.90; I 2 = 44 %) between the two procedures. EUS-GBD had fewer adverse events than PT-GBD (OR 0.43, 95 %CI 0.18 to 1.00; P = 0.05; I 2 = 66 %). Moreover, patients undergoing EUS-GBD had shorter hospital stays, with pooled standard mean difference of – 2.53 (95 %CI – 4.28 to – 0.78; P = 0.005; I 2 = 98 %), and required significantly fewer reinterventions (OR 0.16, 95 %CI 0.04 to 0.042; P < 0.001; I 2 = 32 %) resulting in significantly fewer unplanned readmissions (OR 0.16, 95 %CI 0.05 to 0.53; P = 0.003; I 2 = 79 %). Conclusions EUS-GBD was associated with lower rates of post-procedure adverse events, shorter hospital stays, and fewer reinterventions and readmissions compared with PT-GBD in patients with acute cholecystitis who were unfit for surgery.

Endosonography-guided gallbladder drainage versus percutaneous cholecystostomy in very high-risk surgical patients with acute cholecystitis: an international randomised multicentre controlled superiority trial (DRAC 1)

“…Hence, the use of LAMS is of paramount importance, as the lumen apposing force generated by LAMS is significantly higher than that of other types of stents 25. The safety of the EUS-guided anastomosis is confirmed by the results of the meta-analyses and a few large-scale studies 24 26. In fact, the occurrence of an anastomotic leak after successful placement of a LAMS for acute cholecystitis is exceedingly rare.…”

“…Two studies reported lower readmission rates, three studies reported lower re-intervention rates and one study reported significantly lower 1 year adverse events rates. A meta-analysis then concluded that EUS-GBD also had fewer adverse events than PT-GBD (OR: 0.43; CI 0.18 to 1.00; p=0.05; I 2 =66%), shorter lengths of hospital stay, with pooled standard mean difference of −2.53 (95% CI: −4.28 to −0.78; p=0.005, I 2 =98%); required significantly less re-interventions (OR: 0.16; CI: 0.04 to 0.042; p=0.0002; I 2 =32%) resulting in significantly less unplanned readmissions (OR: 0.16; 95% CI: 0.05 to 0,53; p=0.003, I 2 =79%) 24. The findings of the current study are in-line with the all of the above studies.…”

Endoscopic ultrasound-guided gallbladder drainage as a rescue therapy for unresectable malignant biliary obstruction: a multicenter experience

“…EUS-guided gallbladder drainage (EUS-GBD), commonly used in treating acute cholecystitis in patients who are not surgical candidates, is an attractive salvage therapy when both ERCP and standard EUS-BD techniques are unsuccessful [7,8]. A previous single-center study reported a clinical success rate of 91 % for EUS-GBD in 12 patients who failed ERCP and EUS-BD, with an adverse event rate of 16.7 % [9].…”

Emergent Treatment of Acute Cholangitis and Acute Cholecystitis

“…A recent meta-analysis by Luk et al comparing 206 and 289 EUS-GBD and PT-GBD patients, respectively, found similar rates of technical and clinical success between the two procedures. 26…”