Endoscopic ultrasound-guided gallbladder drainage is the preferred management method for acute cholecystitis patients with high surgical risk, according to research published in Endoscopy.

Data comparing endoscopic transpapillary gallbladder drainage (ETGBD) and endoscopic ultrasound-guided gallbladder drainage (EUSGBD) are limited for patients with acute cholecystitis and have reported conflicting results.

Researchers conducted a meta-analysis to best understand the clinical outcomes of ETGBD, EUSGBD, and percutaneous gallbladder drainage (PCGBD), and to understand the clinical outcomes in this patient population.


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The final meta-analysis included 72 studies, 7 of which had overlapping cohorts. Of the included studies, 22 provided data on ETGBD, 14 provided data on EUSGBD, and 46 provided data on PCGBD. A total of 15,131 patients were included in all studies, with comparable baseline characteristics across all 3 groups.

In terms of treatment, 1223 patients from 22 studies were treated with ETGBD, 557 patients from 14 studies were treated with EUSGBD, and 13,351 from 46 studies were treated with PCGBD. Pooled technical success was calculated at 83% for ETGBD, 95.3% for EUSGBD, and 98.7% for PCGBD. PCGBD demonstrated superior technical success compared with both ETGBD and EUSGBD. Clinically, EUSGBD was superior to both ETGBD and PCGBD (96.7% vs 88.1% vs 89.3%, respectively).

Investigators found that the calculated pooled rates of all adverse events between all 3 groups were comparable. After reviewing results of an adverse event subtype analysis, researchers indicated a statistically significant P value in pooled rates of pancreatitis with ETGBD (5.1%; 95% CI, 3.5-7.3; I²=17; P =.003), bleeding with EUSGBD (4.3%; 95% CI, 2.7-6.8, I²=0, P =.02), perforation with EUSGBD (3.7%; 95% CI, 2.3-6.0, I²= 0, P =.04), and stent migration with PCGBD (7.4%; 95% CI, 5.5-10.0, I²=79, P =.01).

The calculated pooled rate of disease recurrence was 4.6% and 4.2% with ETGBD and EUSGBD, respectively. Rates were comparable between these groups, compared with PCGBD at 10.8%. The pooled all-cause mortality rate was 16.6%, 26%, and 11.2% with ETGBD, EUSGBD, and PCGBD, respectively.

Study limitations include those that are inherent to meta-analyses. Researchers also noted that the included studies were not “entirely representative of the general population and community practice.” An additional limitation was the retrospective nature of the studies included, which contributed to selection bias.

“Based on our meta-analysis of the various [gallbladder drainage] modalities… [EUSGBD] demonstrated superior clinical success compared with [ETGBD] and/or [PCGBD],” the researchers concluded. “We recommend that [EUSGBD] be used as one of the first-line approaches when treating this patient population and is preferably performed in centers with high expertise owing to the chances of rare but serious adverse events.”

Disclosure: One study author declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Mohan BP, Khan SR, Trakroo S, et al. Endoscopic ultrasound-guided gallbladder drainage, transpapillary drainage, or percutaneous drainage in high risk acute cholecystitis patients: systematic review and comparative meta-analysis [published online October 23, 2019]. Endoscopy. doi: 10.1055/a-1020-3932