Skip to main content

Advertisement

SpringerLink
Log in

Meta-analysis of outcomes of endoscopic ultrasound-guided gallbladder drainage versus percutaneous cholecystostomy for the management of acute cholecystitis

  • Review
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Endoscopic ultrasound-guided gallbladder drainage is a novel method of treating acute cholecystitis in patients deemed too high risk for surgery. It involves endoscopic stent placement between the gallbladder and the alimentary tract to internally drain the infection and is an alternative to percutaneous cholecystostomy (PC). This meta-analysis assesses the clinical outcomes of high-risk patients undergoing endoscopic drainage with an acute cholecystoenterostomy (ACE) compared with PC in acute cholecystitis.

Methods

A literature search was performed using the preferred reporting items for systematic reviews and meta-analyses guidelines. Databases were searched for studies reporting outcomes of patients undergoing ACE or PC. Results were reported as mean differences or pooled odds ratios (OR) with 95% confidence intervals (95% CI).

Results

A total of 1593 citations were reviewed; five studies comprising 495 patients were ultimately selected for analysis. There were no differences in technical or clinical success rates between the two groups on pooled meta-analysis. ACE had significantly lower post-procedural pain scores (mean difference − 3.0, 95% CI − 2.3 to − 3.6, p < 0.001, on a 10-point pain scale). There were no statistically significant differences in procedure complications between groups. Re-intervention rates were significantly higher in the PC group (OR 4.3, 95% CI 2.0–9.3, p < 0.001).

Conclusion

ACE is a promising alternative to PC in high-risk patients with acute cholecystitis, with equivalent success rates, improved pain scores and lower re-intervention rates, without the morbidities associated with external drainage.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Roulin D, Saadi A, Di Mare L, Demartines N, Halkic N (2016) Early versus delayed cholecystectomy for acute cholecystitis, are the 72 hours still the rule? A randomized trial. Ann Surg 264(5):717–722

    Article  PubMed  Google Scholar 

  2. Yamashita Y, Takada T, Kawarada Y, Nimura Y, Hirota M, Miura F, Mayumi T, Yoshida M, Strasberg S, Pitt HA (2007) Surgical treatment of patients with acute cholecystitis: Tokyo guidelines. J Hepato-Biliary-Pancreat Sci 14(1):91–97

    Article  Google Scholar 

  3. Atar E, Bachar G, Berlin S, Neiman C, Bleich-Belenky E, Litvin S, Knihznik M, Belenky A, Ram E (2014) Percutaneous cholecystostomy in critically ill patients with acute cholecystitis: complications and late outcome. Clin Radiol 69(6):e247–e252

    Article  CAS  PubMed  Google Scholar 

  4. Spira RM, Nissan A, Zamir O, Cohen T, Fields SI, Freund HR (2002) Percutaneous transhepatic cholecystostomy and delayed laparoscopic cholecystectomy in critically ill patients with acute calculus cholecystitis. Am J Surg 183(1):62–66

    Article  PubMed  Google Scholar 

  5. Welschbillig-Meunier K, Pessaux P, Lebigot J, Lermite E, Aube C, Brehant O, Hamy A, Arnaud J (2005) Percutaneous cholecystostomy for high-risk patients with acute cholecystitis. Surg Endosc Other Interven Tech 19(9):1256–1259

    Article  CAS  Google Scholar 

  6. Sanjay P, Mittapalli D, Marioud A, White RD, Ram R, Alijani A (2013) Clinical outcomes of a percutaneous cholecystostomy for acute cholecystitis: a multicentre analysis. HPB 15(7):511–516

    Article  PubMed  Google Scholar 

  7. Mizrahi I, Mazeh H, Yuval JB, Almogy G, Bala M, Simanovski N, Ata NA, Kuchuk E, Rachmuth J, Nissan A (2015) Perioperative outcomes of delayed laparoscopic cholecystectomy for acute calculous cholecystitis with and without percutaneous cholecystostomy. Surgery 158(3):728–735

    Article  PubMed  Google Scholar 

  8. Choi JH, Lee SS, Park DH, Seo DW, Lee SK, Kim M-h (2014) Outcomes of EUS-guided transmural gallbladder drainage with single-step placement of a self-expandable metal stent in patients with acute cholecystitis unsuitable for cholecystectomy. Off J Int Hepato Pancreat Biliary Assoc 16:81

    Article  Google Scholar 

  9. Khan MA, Atiq O, Kubiliun N, Ali B, Kamal F, Nollan R, Ismail MK, Tombazzi C, Kahaleh M, Baron TH (2017) Efficacy and safety of endoscopic gallbladder drainage in acute cholecystitis: is it better than percutaneous gallbladder drainage? Gastrointest Endosc 85(1):76–87 e73.

    Article  PubMed  Google Scholar 

  10. Law R, Baron TH (2016) Endoscopic ultrasound-guided biliary interventions: an update on recent developments. Curr Opin Gastroenterol 32(3):232–237

    PubMed  Google Scholar 

  11. Lee SS, Park DH, Hwang CY, Ahn C-S, Lee TY, Seo D-W, Lee SK, Kim M-W (2007) EUS-guided transmural cholecystostomy as rescue management for acute cholecystitis in elderly or high-risk patients: a prospective feasibility study. Gastrointest Endosc 66(5):1008–1012

    Article  PubMed  Google Scholar 

  12. Bakker OJ, van Santvoort HC, van Brunschot S et al (2012) Endoscopic transgastric vs surgical necrosectomy for infected necrotizing pancreatitis: a randomized trial. JAMA 307(10):1053–1061

    Article  CAS  PubMed  Google Scholar 

  13. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097

    Article  PubMed  PubMed Central  Google Scholar 

  14. Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5(1):13

    Article  PubMed  PubMed Central  Google Scholar 

  15. Higgins JP, Green S (2011) Cochrane handbook for systematic reviews of interventions. Wiley, Chichester

    Google Scholar 

  16. Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (MINORS): development and validation of a new instrument. ANZ J Surg 73(9):712–716

    Article  PubMed  Google Scholar 

  17. Jang J, Lee S, Song T, Hyun Y, Park D, Seo D, Lee S, Kim M, Yun S (2012) Endoscopic ultrasound-guided transmural and percutaneous transhepatic gallbladder drainage are comparable for acute cholecystitis. Gastroenterology 142:805–811

    Article  PubMed  Google Scholar 

  18. Irani S, Ngamruengphong S, Teoh A, Will U, Nieto J, Abu Dayyeh BK, Gan SI, Larsen M, Yip HC, Topazian MD, Levy MJ, Thompson CC, Storm AC, Hajiyeva G, Ismail A, Chen YI, Bukhari M, Chavez YH, Kumbhari V, Khashab MA (2017) Similar efficacies of endoscopic ultrasound gallbladder drainage with a lumen-apposing metal stent versus percutaneous transhepatic gallbladder drainage for acute cholecystitis. Clin Gastroenterol Hepatol 15(5):738–745

    Article  PubMed  Google Scholar 

  19. Teoh AY, Serna C, Penas I, Chong CC, Perez-Miranda M, Ng EK, Lau JY (2017) Endoscopic ultrasound-guided gallbladder drainage reduces adverse events compared with percutaneous cholecystostomy in patients who are unfit for cholecystectomy. Endoscopy 49(2):130–138

    PubMed  Google Scholar 

  20. Tyberg A, Saumoy M, Sequeiros EV, Giovannini M, Artifon E, Teoh A, Nieto J, Desai AP, Kumta NA, Gaidhane M, Sharaiha RZ, Kahaleh M (2016) EUS-guided versus percutaneous gallbladder drainage: isn’t it time to convert? J Clin Gastroenterol 52(1):79–84

  21. Kedia P, Sharaiha RZ, Kumta NA, Widmer J, Jamal-Kabani A, Weaver K, Benvenuto A, Millman J, Barve R, Gaidhane M, Kahaleh M (2015) Endoscopic gallbladder drainage compared with percutaneous drainage. Gastrointest Endosc 82(6):1031–1036

    Article  PubMed  Google Scholar 

  22. Irani S, Ngamruengphong S, Teoh A, Will U, Nieto J, Abu Dayyeh BK, Gan SI, Larsen M, Yip HC, Topazian MD, Levy MJ, Thompson CC, Storm AC, Hajiyeva G, Ismail A, Chen YI, Bukhari M, Chavez YH, Kumbhari V, Khashab MA (2016) Similar efficacies of endoscopic ultrasound gallbladder drainage with a lumen-apposing metal stent vs percutaneous transhepatic gallbladder drainage for acute cholecystitis. Clin Gastroenterol Hepatol 15(5):738–745

  23. Siegel JH, Kasmin FE (1997) Biliary tract diseases in the elderly: management and outcomes. Gut 41(4):433–435

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Kortram K, van Ramshorst B, Bollen TL, Besselink MG, Gouma DJ, Karsten T, Kruyt PM, Nieuwenhuijzen GA, Kelder JC, Tromp E, Boerma D (2012) Acute cholecystitis in high risk surgical patients: percutaneous cholecystostomy versus laparoscopic cholecystectomy (CHOCOLATE trial): study protocol for a randomized controlled trial. Trials 13:7

    Article  PubMed  PubMed Central  Google Scholar 

  25. Xu M-M, Kahaleh M (2016) EUS-guided transmural gallbladder drainage: a new era has begun. SAGE Publications, London, England

    Google Scholar 

  26. A randomized controlled trial on EGBD vs PC for acute cholecystitis. Full text view—https://ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT02212717?term=cholecystostomy&rank=2

Download references

Funding

This research did not receive any specific Grant from funding agencies in the public, commercial or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Upper Gastrointestinal Surgery, Beaumont Hospital, Dublin 9, Ireland

    Ola Ahmed, Ailin C. Rogers, Jarlath C. Bolger, Achille Mastrosimone & William B. Robb

  2. Department of Radiology, Beaumont Hospital, Dublin 9, Ireland

    Michael J. Lee & Aoife N. Keeling

  3. Department of Gastroenterology, Beaumont Hospital, Dublin 9, Ireland

    Daniel Cheriyan

  4. Department of General and Upper GI Surgery, Beaumont Hospital, Dublin 9, Ireland

    Ailin C. Rogers

Authors
  1. Ola Ahmed
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ailin C. Rogers
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jarlath C. Bolger
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Achille Mastrosimone
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael J. Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Aoife N. Keeling
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Daniel Cheriyan
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. William B. Robb
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ailin C. Rogers.

Ethics declarations

Disclosure

Drs Ola Ahmed, Ailin Rogers, Jarlath C. Bolger, Achille Mastrosimone, Michael J. Lee, Aoife N. Keeling, Daniel Cheriyan and William B. Robb have no conflict of interest or financial ties to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ahmed, O., Rogers, A.C., Bolger, J.C. et al. Meta-analysis of outcomes of endoscopic ultrasound-guided gallbladder drainage versus percutaneous cholecystostomy for the management of acute cholecystitis. Surg Endosc 32, 1627–1635 (2018). https://doi.org/10.1007/s00464-018-6041-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-018-6041-3

Keywords

Search

Navigation