Su1283 EFFICACY AND SAFETY OF LUMEN APPOSING SELF-EXPANDABLE METAL STENTS FOR EUS GUIDED CHOLECYSTOSTOMY: AN UPDATED META-ANALYSIS AND SYSTEMATIC REVIEW

Abstract

Background: Early cholecystectomy is the recommended treatment for patients with acute cholecystitis. A subset of these patients are unfit for surgery due to late presentation and comorbidities. Prompt gallbladder drainage (GBD) with percutaneous or endoscopic approach remains a viable therapeutic option for non-operative candidates. Endoscopic ultrasound (EUS) guided transluminal gallbladder drainage (EUS-GBD) continues to evolve as a viable alternative approach to percutaneous drainage. Advanced endoscopic techniques along with refinement in lumen apposing self-expandable mental stents (LAMS) offer several advantages. Current literature on the efficacy of EUS-GBD has been varied. We performed a pooled analysis on the efficacy and safety of EUS-GBD with LAMS in non-operative candidates with acute cholecystitis. Methods: Extensive English language literature search was performed in Medline, Embase, Cochrane central and Google scholar using keywords "endoscopic ultrasound", "stent", "gallbladder", "acute cholecystitis" and "cholecystostomy" from Jan. 2000 to Nov. 2019. Fixed and random effects models were used to calculate the pooled proportions. Results: Data was extracted from 19 studies that met the inclusion criteria (nZ480). Pooled proportion of technical success was 95.92% (95% CI Z 94.01 to 97.48) and clinical success was 93.05% (95% CI Z 90.04 to 95.55). Overall complication rate was 16.92 % (95% CI Z 11.30 to 23.42) and stent related complication rate was 7.03% (95% CI Z 4.24 to 10.45) in the pooled percentage of patients. Pooled proportion for perforation was 4.77% (95% CI Z 2.77 to 7.28) and total deaths was noted in 18.44% (95% CI Z 8.48 to 31.18). Pooled proportion for obstruction was 4.23% (95% CI Z 2.10 to 7.05) and recurrent cholangitis/cholecystitis was noted in 3.75% (95% CI Z 2.16 to 5.76). Proportion of tissue overgrowth was 4.65% (95% CI Z 1.85 to 8.63) with stent removal noted in 9.21% (CI Z 3.38 to 17.51). Inability to remove the stent was noted in 5.10% (95% CI Z 0.13 to 16.60). Pooled estimates were similar using random and fixed models.