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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

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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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Authors and Affiliations

Authors

Contributions

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.

Corresponding author

Correspondence to Igor Braga Ribeiro.

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Disclosures

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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