EUS-guided gallbladder drainage versus laparoscopic cholecystectomy for acute cholecystitis: a propensity score analysis with 1-year follow-up data

      Background and Aims

      EUS-guided gallbladder drainage (EUS-GBD) is a safe alternative to percutaneous cholecystostomy (PT-GBD) for acute cholecystitis. How the procedure compares with laparoscopic cholecystectomy (LC) is uncertain. The aim of the current study is to compare the outcomes of EUS-GBD with LC for acute cholecystitis.

      Methods

      This was propensity score analysis of all patients admitted for acute cholecystitis between 2012 and 2018. Consecutive patients who received EUS-GBD or LC were included. Patients were matched for age, sex, and age-adjusted Charlson score. Outcome measurements included 30-day adverse events, mortality, recurrent cholecystitis, recurrent biliary events, reinterventions, and readmissions.

      Results

      During the study period, 60 patients were selected (30 EUS-GBD vs 30 LC) after propensity score matching. Technical success rates (100% vs 100%), clinical success rates (93.3% vs 100%, P = 1), lengths of hospital stay (6.8 [8.1] vs 5.5 [2.7], P = 1), 30-day adverse events (4 [13.3%] vs 4 [13.3%], P = 1), and mortality rates (2 [6.7%] vs 0 [0%], P = .492) were similar. The rates of recurrent biliary events (3 [10%] vs 3 [10%], P = .784), reinterventions (4 [13.3%] vs 3 [10%], P = 1), and unplanned readmissions (3 [10%] vs 3 [10%], P = .784) in 1 year were also similar.

      Conclusions

      The outcomes of EUS-GBD for acute cholecystitis were comparable with LC with acceptable rates of recurrent acute cholecystitis. These results support the role of EUS-GBD as an alternative to LC in patients who may or may not be surgically fit to undergo definitive cholecystectomy.

      Graphical abstract

      Abbreviations:

      EUS-GBD (EUS-guided gallbladder drainage), LAMS (lumen-apposing metal stent), LC (laparoscopic cholecystectomy), PT-GBD (percutaneous cholecystostomy gallbladder drainage)
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      Linked Article

      • EUS-guided gallbladder drainage is as good as laparoscopic cholecystectomy for symptomatic cholelithiasis: Wait!…what?!
        Gastrointestinal EndoscopyVol. 93Issue 3
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          Gallbladder interventions have evolved greatly over the past several hundred years. Because of the belief that humans could not live without a gallbladder, the earliest surgical intervention was cholecystostomy with removal of fluid and stones.1 The first successful cholecystectomy was performed in Germany in 1882.1 Nearly 100 years later, the first percutaneous cholecystostomy was performed in 19802 followed by the first laparoscopic cholecystectomy in 1985.1 Although transpapillary gallbladder drainage was described in 1990,3 it has not been widely accepted outside of tertiary centers because of technical complexities and constraints of the small-diameter cystic duct that allows placement of only small-diameter stents.
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