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Surgical Endoscopy
Published in: Surgical Endoscopy 5/2020

01-05-2020 | Cholecystitis | Review Article

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

Authors: Rajesh Krishnamoorthi, Mahendran Jayaraj, Viveksandeep Thoguluva Chandrasekar, Dhruv Singh, Joanna Law, Michael Larsen, Andrew Ross, Richard Kozarek, Shayan Irani

Published in: Surgical Endoscopy | Issue 5/2020

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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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Metadata
Title
EUS-guided versus endoscopic transpapillary gallbladder drainage in high-risk surgical patients with acute cholecystitis: a systematic review and meta-analysis
Authors
Rajesh Krishnamoorthi
Mahendran Jayaraj
Viveksandeep Thoguluva Chandrasekar
Dhruv Singh
Joanna Law
Michael Larsen
Andrew Ross
Richard Kozarek
Shayan Irani
Publication date
01-05-2020
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 5/2020
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-020-07409-7

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