EUS-GUIDED VS PERCUTANEOUS DRAINAGE FOR ACUTE CHOLECYSTITIS IN HIGH-RISK PATIENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Aims:

EUS-guided gallbladder drainage (EUS-GBD) is an alternative treatment for acute cholecystitis in patients unfit for surgery when transpapillary drainage fails. Percutaneous cholecystostomy (PT-GBD) offers an alternative temporary measure with clinical success rates over 95% in acute cholecystitis; however, it is associated with high morbidity. A meta-analysis was performed to compare the clinical outcome of EUS-GBD and PT-GBD for acute cholecystitis in high-risk patients.

Methods:

a medical literature search using Embase, Pubmed and Cochrane was performed, aimed at identifing studies comparing EUS-GBD and PT-GBD in patients with acute cholecystitis at high surgical risk. Outcome measures were clinical and technical success, overall AE and type of AE, re-admission, recurrence and re-intervention rate, mortality and pain score. Results were reported as mean differences or pooled odds ratios (OR) with 95% confidence intervals (95% CI). Heterogeneity was assessed by measuring I².

Results:

We identified 7 studies (6 observational and 1 RCT) for a total of 805 patients.

EUS-GBD had a greater technical success (OR 0.39 95% CI 0.16 – 0.97), and lower pain score (MD -2.95 95% CI -2.60; – 2.30), re-intervention rate (OR 0.24 95% CI 0.11 – 0.51) and re-admission to hospital rate (OR 0.21 95% CI 0.12 – 0.37) compared to PT-GBD. No difference emerged in clinical success (OR 0.68 95% CI 0.38 – 1.21) adverse events (OR 0.69 95% CI 0.28 – 1.70) and mortality (OR 1.04, 95% CI 0.35 – 3.11).

Conclusions:

EUS-GBD is a safe and effective procedure that reduces the need for re-intervention.

In patients who are poor surgical candidates it should become the first choice treatment in tertiary care centres with expert endoscopists.