EUS-guided gallbladder drainage vs dual stent transpapillary gallbladder drainage for management of acute cholecystitis

Abstract

Background and study aims

Cholecystectomy (CCY) is the standard treatment for acute cholecystitis. For non-surgical patients, percutaneous cholecystostomy tube (PT-GBD) is recommended but is associated with high readmission rates and poor quality of life. Endoscopic gallbladder decompression techniques, including endoscopic transpapillary gallbladder drainage (ET-GBD) and endoscopic ultrasound-guided gallbladder drainage (EUS-GBD), are alternatives. Studies comparing ET-GBD and EUS-GBD have shown EUS-GBD to have superior outcomes. However, these studies assessed ET-GBD mostly via single transcystic stent placement (SSET-GBD). This study aimed to compare outcomes of dual transcystic stents (DSET-GBD) and EUS-GBD in non-surgical candidates with acute cholecystitis.

Patients and methods

A multicenter analysis was conducted on patients who underwent ET-GBD or EUS-GBD between January 2019 and January 2023. Data were extracted from electronic medical records and outcomes including technical success, success, adverse events (AEs), and recurrence rates of cholecystitis were measured.

Results

Of 129 procedures (56 EUS-GBD; 73 ET-GBD), technical success was achieved in 87.5% of EUS-GBD and 86.3% of ET-GBD attempts. Immediate clinical success was achieved in 98.1% for EUS-GBD and 100% for DSET-GBD. AE rates were similar between the groups. Recurrent cholecystitis rates were 5.3% for EUS-GBD and 8.2% for DSET-GBD (P = 0.692).

Conclusions

This study demonstrates that DSET-GBD has similarly low rates of recurrent acute cholecystitis compared with EUS-GBD. DSET-GBD should be considered as an alternative management strategy for management of acute cholecystitis in patients who are unable to undergo CCY.

Keywords

Endoscopic ultrasonography - Pancreatobiliary (ERCP/PTCD) - ERC topics - Intervention EUS

Publication History

Received: 24 June 2024

Accepted after revision: 16 December 2024

Accepted Manuscript online:
02 January 2025

Article published online:
29 January 2025

• References

• 1 Baron TH, Grimm IS, Swanstrom LL. Interventional approaches to gallbladder disease. N Engl J Med 2015; 373: 357-365
• 2 Lu P, Chan C-L, Yang N-P. et al. Outcome comparison between percutaneous cholecystostomy and cholecystectomy: A 10-year population-based analysis. BMC Surg 2017; 17: 1-12
• 3 Wiggins T, Markar SR, Mackenzie H. et al. Evolution in the management of acute cholecystitis in the elderly: population-based cohort study. Surg Endosc 2018; 32: 4078-4086
• 4 Siddiqui A, Kunda R, Tyberg A. et al. Three-way comparative study of endoscopic ultrasound-guided transmural gallbladder drainage using lumen-apposing metal stents versus endoscopic transpapillary drainage versus percutaneous cholecystostomy for gallbladder drainage in high-risk surgical patients with acute cholecystitis: Clinical outcomes and success in an international, multicenter study. Surg Endosc 2019; 33: 1260-1270
• 5 Saumoy M, Yang J, Bhatt A. et al. Endoscopic therapies for gallbladder drainage. Gastrointest Endosc 2021; 94: 671-684
• 6 Higa JT, Sahar N, Kozarek RA. et al. EUS-guided gallbladder drainage with a lumen-apposing metal stent versus endoscopic transpapillary gallbladder drainage for the treatment of acute cholecystitis (with videos). Gastrointest Endosc 2019; 90: 483-492
• 7 Storm AC, Vargas EJ, Chin JY. et al. Transpapillary gallbladder stent placement for long-term therapy of acute cholecystitis. Gastrointest Endosc 2021; 94: 742-748 e741
• 8 Wakabayashi G, Iwashita Y, Hibi T. et al. Tokyo Guidelines 2018: Surgical management of acute cholecystitis: safe steps in laparoscopic cholecystectomy for acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci 2018; 25: 73-86
• 9 Cotton PB, Eisen GM, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
• 10 Irani SS, Sharzehi K, Siddiqui UD. AGA Clinical Practice Update on Role of EUS-Guided Gallbladder Drainage in Acute Cholecystitis: Commentary. Clin Gastroenterol Hepatol 2023; 21: 1141-1147
• 11 Krishnamoorthi R, Jayaraj M, Thoguluva Chandrasekar V. et al. EUS-guided versus endoscopic transpapillary gallbladder drainage in high-risk surgical patients with acute cholecystitis: a systematic review and meta-analysis. Surg Endosc 2020; 34: 1904-1913
• 12 Teoh AYB, Ho LKY, Dhir VK. et al. A multi-institutional survey on the practice of endoscopic ultrasound (EUS) guided pseudocyst drainage in the Asian EUS group. Endosc Int Open 2015; 3: E130-E133