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EUS-guided versus endoscopic transpapillary gallbladder drainage in high-risk surgical patients with acute cholecystitis: a systematic review and meta-analysis

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In patients with acute cholecystitis who are deemed high risk for cholecystectomy, percutaneous cholecystostomy (PC) was historically performed for gallbladder drainage (GBD). There are several limitations associated with PC. Endoscopic GBD [Endoscopic transpapillary GBD (ET-GBD) and EUS-guided GBD (EUS-GBD)] is an alternative to PC. We performed a systematic review and meta-analysis to compare the effectiveness and safety of EUS-GBD versus ET-GBD.


We performed a systematic search of multiple databases through May 2019 to identify studies that compared outcomes of EUS-GBD versus ET-GBD in the management of acute cholecystitis in high-risk surgical patients. Pooled odds ratios (OR) of technical success, clinical success and adverse events between EUS-GBD and ET-GBD groups were calculated.


Five studies with a total of 857 patients (EUS-GBD vs ET-GBD: 259 vs 598 patients) were included in the analysis. EUS-GBD was associated with higher technical [pooled OR 5.22 (95% CI 2.03–13.44; p = 0.0006; I2 = 20%)] and clinical success [pooled OR 4.16 (95% CI 2.00–8.66; p = 0.0001; I2 = 19%)] compared to ET-GBD. There was no statistically significant difference in the rate of overall adverse events [pooled OR 1.30 (95% CI 0.77–2.22; p = 0.33, I2 = 0%)]. EUS-GBD was associated with lower rate of recurrent cholecystitis [pooled OR 0.33 (95% CI 0.14–0.79; p = 0.01; I2 = 0%)]. There was low heterogeneity in the analyses.


EUS-GBD has higher rate of technical and clinical success compared to ET-GBD. While the rates of overall adverse events are statistically similar, EUS-GBD has lower rate of recurrent cholecystitis. Hence, EUS-GBD is preferable to ET-GBD for endoscopic management of acute cholecystitis in select high-risk surgical patients.

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  1. Dana O, Brian B, Rosemurgy AS, Zervos EE (2005) Twenty-millimeter laparoscopic cholecystectomy: fewer ports results in less pain, shorter hospitalization, and faster recovery. Am Surg 71(4):298–302

    Google Scholar 

  2. 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  Google Scholar 

  3. McKay A, Abulfaraj M, Lipschitz J (2012) Short-and long-term outcomes following percutaneous cholecystostomy for acute cholecystitis in high-risk patients. Surg Endosc 26(5):1343–1351

    Article  Google Scholar 

  4. Byrne MF, Suhocki P, Mitchell RM, Pappas TN, Stiffler HL, Jowell PS et al (2003) Percutaneous cholecystostomy in patients with acute cholecystitis: experience of 45 patients at a US referral center. J Am Coll Surg 197(2):206–211

    Article  Google Scholar 

  5. Itoi T, Coelho-Prabhu N, Baron TH (2010) Endoscopic gallbladder drainage for management of acute cholecystitis. Gastrointest Endosc 71(6):1038–1045

    Article  Google Scholar 

  6. Irani S, Baron TH, Grimm IS, Khashab MA (2015) EUS-guided gallbladder drainage with a lumen-apposing metal stent (with video). Gastrointest Endosc 82(6):1110–1115

    Article  Google Scholar 

  7. Kozarek RA (1984) Selective cannulation of the cystic duct at time of ERCP. J Clin Gastroenterol 6(1):37–40

    CAS  PubMed  Google Scholar 

  8. Lee TH, Park DH, Lee SS, Seo DW, Park SH, Lee SK et al (2011) Outcomes of endoscopic transpapillary gallbladder stenting for symptomatic gallbladder diseases: a multicenter prospective follow-up study. Endoscopy 43(08):702–708

    Article  CAS  Google Scholar 

  9. Baron TH, Topazian MD (2007) Endoscopic transduodenal drainage of the gallbladder: implications for endoluminal treatment of gallbladder disease. Gastrointest Endosc 65(4):735–737

    Article  Google Scholar 

  10. Khan MA, Atiq O, Kubiliun N, Ali B, Kamal F, Nollan R et al (2017) Efficacy and safety of endoscopic gallbladder drainage in acute cholecystitis: is it better than percutaneous gallbladder drainage? Gastrointest Endosc 85(1):76–87

    Article  Google Scholar 

  11. Peñas-Herrero I, de la Serna-Higuera C, Perez-Miranda M (2015) Endoscopic ultrasound-guided gallbladder drainage for the management of acute cholecystitis (with video). J Hepato Biliary Pancreat Sci 22(1):35–43

    Article  Google Scholar 

  12. Anderloni A, Di Leo M, Carrara S, Fugazza A, Maselli R, Buda A et al (2018) Endoscopic ultrasound-guided transmural drainage by cautery-tipped lumen-apposing metal stent: exploring the possible indications. Ann Gastroenterol 31(6):735

    PubMed  PubMed Central  Google Scholar 

  13. Seerden TC, Vleggaar FP (2016) Endoscopic removal of buried lumen-apposing metal stents used for cystogastrostomy and cholecystogastrostomy. Endoscopy 48(S 01):E179

    Article  Google Scholar 

  14. Baron TH, Grimm IS, Swanstrom LL (2015) Interventional approaches to gallbladder disease. N Engl J Med 373(4):357–365

    Article  CAS  Google Scholar 

  15. Oh D, Song TJ, Cho DH, Park DH, Seo DW, Lee SK et al (2019) EUS-guided cholecystostomy versus endoscopic transpapillary cholecystostomy for acute cholecystitis in high-risk surgical patients. Gastrointest Endosc 89(2):289–298

    Article  Google Scholar 

  16. Siddiqui A, Kunda R, Tyberg A, Arain MA, Noor A, Mumtaz T et al (2018) 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 33(4):1–11

    Google Scholar 

  17. Higa JT, Sahar N, Kozarek RA, La Selva D, Larsen MC, Gan S-I, Ross AS, Irani SS (2019) 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.

    Article  PubMed  Google Scholar 

  18. Teeratorn N, Ridtitid W, Piyachaturawat P, Kongkam P, Rerknimitr R (2019) 1029 Outcomes of endoscopic gallbladder drainage in acute cholecystitis: transpapillary approach versus endoscopic ultrasoud-guided transmural approach. Gastrointest Endosc 89(6):AB132-AB133.

  19. Matsubara S, Nakai Y, Isayama H, Ishigaki K, Umefune G, Watanabe T et al. (2016) Su1289 endoscopic ultrasonography-guided gallbladder drainage is superior to endoscopic transpapillary gallbladder drainage for acute cholecystitis. Gastrointest Endosc 83(5):AB339.

  20. Higgins JP, Gree Higgins JP, Green S (eds) (2008) Cochrane handbook for systematic reviews of interventions. Wiley, Hoboken

    Google Scholar 

  21. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151(4):264–269

    Article  Google Scholar 

  22. Stroup DF, Berlin JA, Morton SC et al (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting: Meta-analysis of Observational Studies in Epidemiology (MOOSE) group. JAMA 283:2008–2012

    Article  CAS  Google Scholar 

  23. Wells GASB (2001) The Newcastle-Ottawa Scale (NOS) for assessing the quality of non randomised studies in meta-analyses.

  24. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7(3):177–188

    Article  CAS  Google Scholar 

  25. Guyatt GH, Oxman AD, Kunz R, Woodcock J, Brozek J, Helfand M et al (2011) GRADE guidelines: 7. Rating the quality of evidence–inconsistency. J Clin Epidemiol 64(12):1294–1302

    Article  Google Scholar 

  26. Mori Y, Itoi T, Baron TH, Takada T, Strasberg SM, Pitt HA et al (2018) Tokyo Guidelines 2018: management strategies for gallbladder drainage in patients with acute cholecystitis (with videos). J Hepato Biliary Pancreat Sci 25(1):87–95

    Article  Google Scholar 

  27. Chan JHY, Teoh AYB (2018) Current status of endoscopic gallbladder drainage. Clin Endosc 51(2):150

    Article  Google Scholar 

  28. Higa JT, Irani SS (2019) Endoscopic methods for gallbladder drainage. Curr Treat Opt Gastroenterol 17(3):357–366

    Article  Google Scholar 

  29. Kaura K, Bazerbachi F, Sawas T, Levy MJ, Martin JA, Storm AC et al (2019) Surgical outcomes of ERCP-guided transpapillary gallbladder drainage versus percutaneous cholecystostomy as bridging therapies for acute cholecystitis followed by interval cholecystectomy. HPB.

    Article  PubMed  Google Scholar 

  30. Itoi T, Takada T, Hwang TL, Endo I, Akazawa K, Miura F et al (2017) Percutaneous and endoscopic gallbladder drainage for acute cholecystitis: international multicenter comparative study using propensity score-matched analysis. J Hepato Biliary Pancreat Sci 24(6):362–368

    Article  Google Scholar 

  31. Iino C, Shimoyama T, Igarashi T, Aihara T, Ishii K, Sakamoto J et al (2018) Comparable efficacy of endoscopic transpapillary gallbladder drainage and percutaneous transhepatic gallbladder drainage in acute cholecystitis. Endosc Int Open 6(05):E594–E601

    Article  Google Scholar 

  32. Inoue T, Okumura F, Kachi K, Fukusada S, Iwasaki H, Ozeki T et al (2016) Long-term outcomes of endoscopic gallbladder stenting in high-risk surgical patients with calculous cholecystitis (with videos). Gastrointest Endosc 83(5):905–913

    Article  Google Scholar 

  33. Luk SWY, Irani S, Krishnamoorthi R, Lau JYW, Ng EKW, Teoh AYB (2019) Endoscopic ultrasound-guided gallbladder drainage versus percutaneous cholecystostomy for high risk surgical patients with acute cholecystitis: a systematic review and meta-analysis. Endoscopy 51(8):722–732

    Article  Google Scholar 

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Dr. Andrew Ross is a consultant for Boston Scientific. Dr. Richard Kozarek receives research funding from Boston Scientific with remittance to the clinic.

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Authors and Affiliations



Manuscript inception: RK, MJ; Data acquisition and statistical analysis: RK, MJ,VST, DS; Drafting of manuscript: RK, MJ, VST, DS; Critical revision and final approval: RK, MJ, VST, DS, JL, AR, RK, SI.

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Correspondence to Rajesh Krishnamoorthi.

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Drs. Rajesh Krishnamoorthi, Mahendran Jayaraj, Vivek Sandeep Thoguluvachandrasekar, Dhruv Singh, Joanna Law, Michael Larsen and Shayan Irani have no conflicts of interest or financial ties to disclose.

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Supplementary file1 (JPG 45 kb). Supplementary Figure 1: Forest plot for perforations in EUSGBD vs ETGBD

Supplementary file2 (JPG 44 kb). Supplementary Figure 2: Forest plot for Bleeding in EUSGBD vs ETGBD

Supplementary file3 (JPG 42 kb). Supplementary Figure 3: Forest plot for Bile Leak in EUSGBD vs ETGBD

Supplementary file4 (JPG 41 kb). Supplementary Figure 4: Forest plot for pain in EUSGBD vs ETGBD

Supplementary file5 (JPG 41 kb). Supplementary Figure 5: Forest plot for Stent Migration in EUSGBD vs ETGBD


Supplementary file6 (JPG 39 kb). Supplementary Figure 6: Forest plot for technical success in EUSGBD using LAMS vs ETGBD

Supplementary file7 (JPG 39 kb). Supplementary Figure 7: Forest plot for clinical success in EUSGBD using LAMS vs ETGBD


Supplementary file8 (JPG 37 kb). Supplementary Figure 8: Forest plot for overall adverse events in EUSGBD using LAMS vs ETGBD

Supplementary file9 (DOCX 16 kb)

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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 34, 1904–1913 (2020).

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