Abstract
Background and aim
Surgical cholecystectomy is the gold standard strategy for the management of acute cholecystitis (AC). However, some patients are considered unfit for surgery due to certain comorbid conditions. As such, we aimed to compare less invasive treatment strategies such as endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) and percutaneous gallbladder drainage (PT-GBD) for the management of patients with AC who are suboptimal candidates for surgical cholecystectomy.
Methods
A comprehensive search of multiple electronic databases was performed to identify all the studies comparing EUS-GBD versus PT-GBD for patients with AC who were unfit for surgery. A subgroup analysis was also performed for comparison of the group undergoing drainage via cautery-enhanced lumen-apposing metal stents (LAMS) versus PT-GBD. The outcomes included technical and clinical success, adverse events (AEs), recurrent cholecystitis, reintervention, and hospital readmission.
Results
Eleven studies including 1155 patients were included in the statistical analysis. There was no difference between PT-GBD and EUS-GBD in all the evaluated outcomes. On the subgroup analysis, the endoscopic approach with cautery-enhanced LAMS was associated with lower rates of adverse events (RD = − 0.33 (95% CI − 0.52 to − 0.14; p = 0.0006), recurrent cholecystitis (− 0.05 RD (95% CI − 0.09 to − 0.02; p = 0.02), and hospital readmission (− 0.36 RD (95% CI–0.70 to – 0.03; p = 0.03) when compared to PT-GBD. All other outcomes were similar in the subgroup analyses.
Conclusions
EUS-GBD using cautery-enhanced LAMS is superior to PT-GBD in terms of safety profile, recurrent cholecystitis, and hospital readmission rates in the management of patients with acute cholecystitis who are suboptimal candidates for cholecystectomy. However, when cautery-enhanced LAMS are not used, the outcomes of EUS-GBD and PT-GBD are similar. Thus, EUS-GBD with cautery-enhanced LAMS should be considered the preferable approach for gallbladder drainage for this challenging population.
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References
Gomes CA, Junior CS, Di Saveiro S, Sartelli M, Kelly MD, Gomes CC, Gomes FC, Correa LD, Alves CB, de Guimarães S, F, (2017) Acute calculous cholecystitis: Review of current best practices. World J Gastrointest Surg 9:118. https://doi.org/10.4240/wjgs.v9.i5.118
Teoh AB (2019) Outcomes and limitations in EUS-guided gallbladder drainage. Endosc Ultrasound 8:40. https://doi.org/10.4103/eus.eus_49_19
Boregowda U, Umapathy C, Nanjappa A, Wong H, Desai M, Roytman M, Theethira T, Saligram S (2018) Endoscopic ultrasound guided gallbladder drainage—is it ready for prime time? World J Gastrointest Pharmacol Ther 9:47–54. https://doi.org/10.4292/wjgpt.v9.i6.47
James T, Baron T (2019) EUS-guided gallbladder drainage: A review of current practices and procedures. Endosc Ultrasound 8:28. https://doi.org/10.4103/eus.eus_41_19
Park SW, Lee SS (2021) Current status of endoscopic management of cholecystitis. Dig Endosc. https://doi.org/10.1111/den.14083
Fugazza A, Colombo M, Repici A, Anderloni A (2020) Endoscopic ultrasound-guided gallbladder drainage: current perspectives. Clin Exp Gastroenterol 13:193–201. https://doi.org/10.2147/CEG.S203626
Mori Y, Itoi T, Baron TH, Takada T, Strasberg SM, Pitt HA, Ukai T, Shikata S, Noguchi Y, Teoh AYB, Kim M-H, Asbun HJ, Endo I, Yokoe M, Miura F, Okamoto K, Suzuki K, Umezawa A, Iwashita Y, Hibi T, Wakabayashi G, Han H-S, Yoon Y-S, Choi I-S, Hwang T-L, Chen M-F, Garden OJ, Singh H, Liau K-H, Huang WS-W, Gouma DJ, Belli G, Dervenis C, de Santibañes E, Giménez ME, Windsor JA, Lau WY, Cherqui D, Jagannath P, Supe AN, Liu K-H, Su C-H, Deziel DJ, Chen X-P, Fan ST, Ker C-G, Jonas E, Padbury R, Mukai S, Honda G, Sugioka A, Asai K, Higuchi R, Wada K, Yoshida M, Mayumi T, Hirata K, Sumiyama Y, Inui K, Yamamoto M (2018) Tokyo Guidelines 2018: management strategies for gallbladder drainage in patients with acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci 25:87–95. https://doi.org/10.1002/jhbp.504
Baron TH, Topazian MD (2007) Endoscopic transduodenal drainage of the gallbladder: implications for endoluminal treatment of gallbladder disease. Gastrointest Endosc 65:735–737. https://doi.org/10.1016/j.gie.2006.07.041
Law R, Baron TH (2018) Endoscopic ultrasound-guided gallbladder drainage. Gastrointest Endosc Clin N Am 28:187–195. https://doi.org/10.1016/j.giec.2017.11.006
Rana SS (2021) Endoscopic ultrasound-guided gallbladder drainage: a technical review. Ann Gastroenterol 34:142–148. https://doi.org/10.20524/aog.2020.0568
Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart LA (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 4:1. https://doi.org/10.1186/2046-4053-4-1
Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schünemann HJ (2008) GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 336:924–926. https://doi.org/10.1136/bmj.39489.470347.AD
DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188. https://doi.org/10.1016/0197-2456(86)90046-2
Jang JW, Lee SS, Song TJ, Hyun YS, Park DH, Seo D-W, Lee S-K, Kim M-H, Yun S-C (2012) Endoscopic ultrasound-guided transmural and percutaneous transhepatic gallbladder drainage are comparable for acute cholecystitis. Gastroenterology 142:805–811. https://doi.org/10.1053/j.gastro.2011.12.051
Teoh AYB, Kitano M, Itoi T, Pérez-Miranda M, Ogura T, Chan SM, Serna-Higuera C, Omoto S, Torres-Yuste R, Tsuichiya T, Wong KT, Leung C-H, Chiu PWY, Ng EKW, Lau JYW (2020) Endosonography-guided gallbladder drainage versus percutaneous cholecystostomy in very high-risk surgical patients with acute cholecystitis: an international randomised multicentre controlled superiority trial (DRAC 1). Gut 69:1085–1091. https://doi.org/10.1136/gutjnl-2019-319996
Teoh A, Serna C, Penas I, Chong C, Perez-Miranda M, Ng E, Lau J (2016) Endoscopic ultrasound-guided gallbladder drainage reduces adverse events compared with percutaneous cholecystostomy in patients who are unfit for cholecystectomy. Endoscopy 49:130–138. https://doi.org/10.1055/s-0042-119036
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 Y-I, 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 15:738–745. https://doi.org/10.1016/j.cgh.2016.12.021
Kozakai F, Kanno Y, Ito K, Koshita S, Ogawa T, Kusunose H, Masu K, Sakai T, Murabayashi T, Yonamine K, Kawakami Y, Fujii Y, Miyamoto K, Noda Y (2019) Endoscopic ultrasonography-guided gallbladder drainage as a treatment option for acute cholecystitis after metal stent placement in malignant biliary strictures. Clin Endosc 52:262–268. https://doi.org/10.5946/ce.2018.183
Tyberg A, Saumoy M, Sequeiros EV, Giovannini M, Artifon E, Teoh A, Nieto J, Desai AP, Kumta NA, Gaidhane M, Sharaiha RZ, Kahaleh M (2018) EUS-guided versus percutaneous gallbladder drainage: isn’t it time to convert? J Clin Gastroenterol 52:79–84. https://doi.org/10.1097/MCG.0000000000000786
Saumoy M, Tyberg A, Brown E, Eachempati SR, Lieberman M, Afaneh C, Kunda R, Cosgrove N, Siddiqui A, Gaidhane M, Kahaleh M (2019) Successful cholecystectomy after endoscopic ultrasound gallbladder drainage compared with percutaneous cholecystostomy, can it be done? J Clin Gastroenterol 53:231–235. https://doi.org/10.1097/MCG.0000000000001036
Siddiqui A, Kunda R, Tyberg A, Arain MA, Noor A, Mumtaz T, Iqbal U, Loren DE, Kowalski TE, Adler DG, Saumoy M, Gaidhane M, Mallery S, Christiansen EM, Nieto J, Kahaleh M (2019) 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 pati. Surg Endosc 33:1260–1270. https://doi.org/10.1007/s00464-018-6406-7
Piyachaturawat P, Ridtitid W, Luangsukrerk T, Kongkam P, Rerknimitr R (2020) Su1256 outcomes of non-surgical gallbladder drainage in high-surgical risk patients with acute cholecystitis: percutaneous cholecystostomy versus endoscopic transpapaillary gallbladder stenting versus endoscopic ultrasound-guided transmural gallbladder ST. Gastrointest Endosc. https://doi.org/10.1016/j.gie.2020.03.2102
Shah RN, Khara HS, Iqbal U, Confer B, Khan YI, Diehl DL, Berger AL, Bhanushali A, Widom KA, Torres DM (2020) Sa1395 endoscopic ultrasound-guided gallbladder drainage (EUS-GB) compared to percutaneous gallbladder drainage (PC-GB) for high-risk non-surgical patients with acute cholecystitis: a large academic tertiary care center experience. Gastrointest Endosc. https://doi.org/10.1016/j.gie.2020.03.1128
Jo S, Cho DH, Song TJ, Park DH, Lee SS, Seo DW, Lee SK, Kim M-H (2018) Su1360 long-term outcome of EUS-guided gallbladder drainage vs. percutaneous gallbladder drainage in patients who are unfit for cholecystectomy: which is better? Gastrointest Endosc. https://doi.org/10.1016/j.gie.2018.04.1690
Lera dos Santos ME, Ribeiro IB, Proença IM, de Souza GMV, de Moura DTH, Matuguma SE, de Moura EGH (2022) Endoscopic transgastric cholecystectomy during direct endoscopic necrosectomy for walled-off necrosis of the pancreas. Endoscopy 54:E79–E80. https://doi.org/10.1055/a-1388-6254
Choi J-H, Lee S, Choi J, Park D, Seo D-W, Lee S, Kim M-H (2014) Long-term outcomes after endoscopic ultrasonography-guided gallbladder drainage for acute cholecystitis. Endoscopy 46:656–661. https://doi.org/10.1055/s-0034-1365720
Nam K, Kim D, Lee T, Iwashita T, Nakai Y, Bolkhir A, Castro L, Vazquez-Sequeiros E, de la Serna C, Perez-Miranda M, Lee J, Lee S, Seo D-W, Lee S, Kim M-H, Park D (2018) Patient perception and preference of EUS-guided drainage over percutaneous drainage when endoscopic transpapillary biliary drainage fails: An international multicenter survey. Endosc Ultrasound 7:48. https://doi.org/10.4103/eus.eus_100_17
McCarty TR, Hathorn KE, Bazarbashi AN, Jajoo K, Ryou M, Thompson CC (2021) Endoscopic gallbladder drainage for symptomatic gallbladder disease: a cumulative systematic review meta-analysis. Surg Endosc 35:4964–4985. https://doi.org/10.1007/s00464-020-07758-3
Podboy A, Yuan J, Stave CD, Chan SM, Hwang JH, Teoh AYB (2021) Comparison of EUS-guided endoscopic transpapillary and percutaneous gallbladder drainage for acute cholecystitis: a systematic review with network meta-analysis. Gastrointest Endosc 93:797-804.e1. https://doi.org/10.1016/j.gie.2020.09.040
Kamata K, Takenaka M, Kitano M, Omoto S, Miyata T, Minaga K, Yamao K, Imai H, Sakurai T, Watanabe T, Nishida N, Kudo M (2017) Endoscopic ultrasound-guided gallbladder drainage for acute cholecystitis: Long-term outcomes after removal of a self-expandable metal stent. World J Gastroenterol 23:661. https://doi.org/10.3748/wjg.v23.i4.661
Lyu Y, Li T, Wang B, Cheng Y, Chen L, Zhao S (2021) Endoscopic ultrasound-guided gallbladder drainage versus percutaneous transhepatic gallbladder drainage for acute cholecystitis with high surgical risk: an up-to-date meta-analysis and systematic review. J Laparoendosc Adv Surg Tech 31:1232–1240. https://doi.org/10.1089/lap.2020.0786
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HMC: acquisition of data, analysis, interpretation of data, drafting the article, revising the article, final approval; MDTH: analysis and interpretation of data, revising the article; dMJES: acquisition of data, analysis, interpretation of data, drafting the article, revising the article, final approval; Proença, IM: analysis and interpretation of data, revising the article; RIB: analysis and interpretation of data, revising the article; YEY: analysis and interpretation of data, revising the article; RPHBV: analysis and interpretation of data, revising the article; SLSA: analysis and interpretation of data, revising the article, linguistic correction, final approval; BWM: analysis and interpretation of data, revising the article; dMEGH analysis and interpretation of data, drafting the article, revising the article, final approval.
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Dr. Diogo Turiani Hourneaux De Moura: BariaTek Advanced Soluctions—Scientific Advisory Board Member (Consulting fees). Dr. Sergio A. Sanchéz-Luna: Recipient of the 2021 American Society for Gastrointestinal Endoscopy (ASGE) Endoscopic Training Award by the ASGE and Fujifilm. This was not relevant to this study. Dr. Eduardo Guimaraes Hourneaux De Moura: Olympus – Consultant (Consulting fees), Boston Scientific – Consultant (Consulting fees). They were not relevant to this study. Matheus Candido Hemerly, Epifanio Silvino do Monte Junior, Igor Mendonça Proença, Igor Braga Ribeiro, Erika Yuki Yvamoto, Pedro Henrique Boraschi Vieira Ribas, and Wanderley Marques Bernardo have no relevant conflicts of interest or financial ties to disclose.
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The study was approved by the Research Ethics Committee of the Hospital das Clínicas—University of São Paulo School of Medicine.
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Hemerly, M.C., de Moura, D.T.H., do Monte Junior, E.S. et al. Endoscopic ultrasound (EUS)-guided cholecystostomy versus percutaneous cholecystostomy (PTC) in the management of acute cholecystitis in patients unfit for surgery: a systematic review and meta-analysis. Surg Endosc 37, 2421–2438 (2023). https://doi.org/10.1007/s00464-022-09712-x
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DOI: https://doi.org/10.1007/s00464-022-09712-x