Laparoscopic Cholecystectomy, Endoscopic US-Guided Gallbladder Drainage Outcomes Similar for Cholecystitis

inflammed gallbladder
inflammed gallbladder, cholecystitis
A team of investigators sought to compare outcomes between laparoscopic cholecystectomy and ultrasound-guided gallbladder drainage for the management of acute cholecystitis.

Laparoscopic cholecystectomy (LC) was found to be an acceptable alternative to endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) for patients with acute cholecystitis, according to the results of a propensity score analysis study published in Gastrointestinal Endoscopy.

All patients admitted to the Prince of Wales Hospital in Hong Kong between 2012 and 2018 with acute cholecystitis and having undergone EUS-GBD or LC were retrospectively included.

A total of 74 patients underwent EUS-GBD and 70 underwent LC. The 2 cohorts differed significantly in age (P <.001) and Charlson score (P <.001). After propensity score correction, patients were matched for age, sex, and age-adjusted Charlson score for a total of 30 patients with EUS-GBD and 30 patients with LC included in the 30-day follow-up study.

All procedures were successful on a technical level. Almost all procedures were also successful on a clinical level (93.3% EUS-GBD vs 100% LC; P =1.00). The 2 patients for whom clinical success was not achieved with EUS-GBD experienced aspiration pneumonia and uncontrolled sepsis resulting in death.

No significant differences were noted for length of hospital stay (6.8; standard deviation [SD], 8.1 days vs 5.5; SD, 2.7 days P =1.00), 30-day adverse events (13.3% vs 13.3%; P =1.00), 30-day mortality rate (6.7% vs 0%; P =.492), recurrent biliary events (10% vs 10%; P =.784), reinterventions (13.3% vs 10% P =1.00), and readmissions (10% vs 10%; P =.784) for EUS-GBD and LC, respectively.

Two patients in the EUS-GBD cohort experienced nonfatal adverse events, which were upper gastrointestinal bleeding requiring endoscopic hemostasis and a blocked stent due to gallstones requiring endoscopic insertion of an additional stent. In the LC group, 4 patients experienced nonfatal adverse events, which were intraabdominal collections requiring drainage, multiorgan failure requiring transfer to the intensive care unit, upper gastrointestinal bleeding requiring endoscopic hemostasis, and chest infection requiring treatment with antibiotics.

Limitations of this study include low sample size and short follow-up; in addition, the long-term outcomes of these 2 patient groups remain unclear.

The study authors conclude that EUS-GBD and LC have similar clinical outcomes, making LC an acceptable alternative to EUS-GBD in the setting of acute cholecystitis.

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Teoh AYB, Leung CH, Tam PTH, et al. EUS-guided gallbladder drainage versus laparoscopic cholecystectomy for acute cholecystitis: a propensity score analysis with 1-year follow-up data [published online June 28, 2020]. Gastrointest Endosc. doi:10.1016/j.gie.2020.06.066