Endoscopy 2019; 51(08): 722-732
DOI: 10.1055/a-0929-6603
Original article
© Georg Thieme Verlag KG Stuttgart · New York

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

Sally Wai-Yin Luk
1  Department of Surgery, North District Hospital, Sheung Shui, Hong Kong
,
Shayan Irani
2  Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, United States
,
Rajesh Krishnamoorthi
2  Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, United States
,
James Yun Wong Lau
3  Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, Hong Kong
,
Enders Kwok Wai Ng
3  Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, Hong Kong
,
Anthony Yuen-Bum Teoh
3  Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, Hong Kong
› Author Affiliations
Further Information

Publication History

submitted 20 November 2018

accepted after revision 23 April 2019

Publication Date:
25 June 2019 (eFirst)

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.

Supplementary material, Fig. 1s – 3s