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
Graphical Abstract
Abbreviations:
EUS-GBD (EUS-guided gallbladder drainage), LAMS (lumen-apposing metal stent), LC (laparoscopic cholecystectomy), PT-GBD (percutaneous cholecystostomy gallbladder drainage)To read this article in full you will need to make a payment
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References
- Feasibility of conversion of percutaneous cholecystostomy to internal transmural endoscopic ultrasound-guided gallbladder drainage.Saudi J Gastroenterol. 2017; 23: 318-322
- Percutaneous transhepatic versus EUS-guided gallbladder drainage for malignant cystic duct obstruction.Gastrointest Endosc. 2017; 85: 357-364
- Long-term outcomes after endoscopic ultrasonography-guided gallbladder drainage for acute cholecystitis.Endoscopy. 2014; 46: 656-661
- EUS-guided gallbladder drainage in patients with acute cholecystitis and high surgical risk using an electrocautery-enhanced lumen-apposing metal stent device.Gastrointest Endosc. 2017; 86: 636-643
- EUS-guided gallbladder drainage for rescue treatment of malignant distal biliary obstruction after unsuccessful ERCP.Gastrointest Endosc. 2016; 84: 147-151
- EUS-guided gallbladder drainage with a lumen-apposing metal stent (with video).Gastrointest Endosc. 2015; 82: 1110-1115
- Similar efficacies of endoscopic ultrasound gallbladder drainage with a lumen-apposing metal stent versus percutaneous transhepatic gallbladder drainage for acute cholecystitis.Clin Gastroenterol Hepatol. 2017; 15: 738-745
- EUS-guided gallbladder drainage in patients with cirrhosis: results of a multicenter retrospective study.Endosc Int Open. 2019; 7: E1099-E1104
- Feasibility and safety of EUS-guided transgastric/transduodenal gallbladder drainage with single-step placement of a modified covered self-expandable metal stent in patients unsuitable for cholecystectomy.Gastrointest Endosc. 2011; 74: 176-181
- Endoscopic ultrasound-guided transmural and percutaneous transhepatic gallbladder drainage are comparable for acute cholecystitis.Gastroenterology. 2012; 142: 805-811
- International collaborative study on EUS-guided gallbladder drainage: Are we ready for prime time?.Dig Liver Dis. 2016; 48: 1054-1057
- Endoscopic ultrasound-guided gallbladder drainage for acute cholecystitis: long-term outcomes after removal of a self-expandable metal stent.World J Gastroenterol. 2017; 23: 661-667
- Endoscopic gallbladder drainage compared with percutaneous drainage.Gastrointest Endosc. 2015; 82: 1031-1036
- 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. 2019; 33: 1260-1270
- Outcomes of an international multicenter registry on EUS-guided gallbladder drainage in patients at high risk for cholecystectomy.Endosc Int Open. 2019; 7: E964-E973
- Endoscopic ultrasound-guided gallbladder drainage reduces adverse events compared with percutaneous cholecystostomy in patients who are unfit for cholecystectomy.Endoscopy. 2017; 49: 130-138
- EUS-guided versus percutaneous gallbladder drainage: Isn't it time to convert?.J Clin Gastroenterol. 2018; 52: 79-84
- Tokyo guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos).J Hepatobil Pancreat Sci. 2018; 25: 41-54
- Endoscopic ultrasound-guided gallbladder drainage reduces adverse events compared with percutaneous cholecystostomy in patients who are unfit for cholecystectomy.Endoscopy. 2017; 49: 130-138
- A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.J Chronic Dis. 1987; 40: 373-383
- Randomized trial of early versus delayed laparoscopic cholecystectomy for acute cholecystitis.Br J Surg. 1998; 85: 764-767
- Routine early laparoscopic cholecystectomy for acute cholecystitis after conclusion of a randomized controlled trial.Br J Surg. 2007; 94: 1128-1132
- Tokyo guidelines 2018: flowchart for the management of acute cholecystitis.J Hepatobil Pancreat Sci. 2018; 25: 55-72
- Feasibility of per-oral cholecystoscopy and advanced gallbladder interventions after EUS-guided gallbladder stenting (with video).Gastrointest Endosc. 2017; 85: 1225-1232
- An introduction to propensity score methods for reducing the effects of confounding in observational studies.Multivariate Behav Res. 2011; 46: 399-424
- Equivalence tests: a practical primer for t tests, correlations, and meta-analyses.Soc Psychol Personal Sci. 2017; 8: 355-362
- 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. 2020; 69: 1085-1091
- Endoscopic ultrasound-guided gallbladder drainage versus percutaneous cholecystostomy for high risk surgical patients with acute cholecystitis: a systematic review and meta-analysis.Endoscopy. 2019; 51: 722-732
- Feasibility of per-oral cholecystoscopy and advanced gallbladder interventions after EUS-guided gallbladder stenting (with video).Gastrointest Endosc. 2017; 85: 1225-1232
- Laparoscopic cholecystectomy versus percutaneous catheter drainage for acute cholecystitis in high risk patients (CHOCOLATE): multicentre randomised clinical trial.BMJ. 2018; 363: k3965
- Outcomes in older patients with grade III cholecystitis and cholecystostomy tube placement: a propensity score analysis.J Am Coll Surg. 2017; 224: 502-511
- Successful cholecystectomy after endoscopic ultrasound gallbladder drainage compared with percutaneous cholecystostomy. Can it be done?.J Clin Gastroenterol. 2019; 53: 231-235
- Gallstone recurrence after successful percutaneous cholecystolithotomy: a 10-year follow-up of 439 cases.Hepatobil Pancreat Dis Int. 2007; 6: 199-203
Article info
Publication history
Published online: June 28, 2020
Accepted:
June 21,
2020
Received:
March 26,
2020
Footnotes
DISCLOSURE: The following authors disclosed financial relationships: A. Y. B. Teoh: Consultant for Boston Scientific, Cook, Taewoong, and Microtech Medical. All other authors disclosed no financial relationships.
If you would like to chat with an author of this article, you may contact Dr Teoh at [email protected]
See CME section; p. 727.
Identification
Copyright
© 2021 by the American Society for Gastrointestinal Endoscopy
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Access this article on ScienceDirectLinked Article
- EUS-guided gallbladder drainage is as good as laparoscopic cholecystectomy for symptomatic cholelithiasis: Wait!…what?!Gastrointestinal EndoscopyVol. 93Issue 3
- PreviewGallbladder 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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