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EUS-guided versus endoscopic transpapillary gallbladder drainage in high-risk surgical patients with acute cholecystitis: a systematic review and meta-analysis.
Surgical Endoscopy ( IF 3.1 ) Pub Date : 2020-02-11 , DOI: 10.1007/s00464-020-07409-7
Rajesh Krishnamoorthi 1, 2 , Mahendran Jayaraj 3 , Viveksandeep Thoguluva Chandrasekar 4 , Dhruv Singh 5 , Joanna Law 1 , Michael Larsen 1 , Andrew Ross 1 , Richard Kozarek 1 , Shayan Irani 1
Affiliation  

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.

中文翻译:

EUS引导与内镜下经乳头状胆囊胆囊引流术治疗高危急性胆囊炎的手术患者:系统评价和荟萃分析。

背景技术在被认为是胆囊切除术高风险的急性胆囊炎患者中,过去曾进行过胆囊引流术(GBD)的经皮胆囊造口术(PC)。与PC相关联的一些限制。内窥镜GBD [内窥镜经乳头GBD(ET-GBD)和EUS引导的GBD(EUS-GBD)]是PC的替代选择。我们进行了系统的回顾和荟萃分析,以比较EUS-GBD与ET-GBD的有效性和安全性。方法我们在2019年5月之前对多个数据库进行了系统搜索,以鉴定比较EUS-GBD与ET-GBD在高危手术患者急性胆囊炎治疗中的结果的研究。计算EUS-GBD和ET-GBD组之间技术成功,临床成功和不良事件的合并比值比(OR)。结果分析共纳入五项研究,共857例患者(EUS-GBD vs ET-GBD:259 vs 598患者)。EUS-GBD与更高的技术水平[合并OR 5.22(95%CI 2.03-13.44; p = 0.0006; I2 = 20%)]和临床成功率[合并OR 4.16(95%CI 2.00-8.66; p = 0.0001; I2 = 19%)]。总体不良事件发生率没有统计学上的显着差异[合并OR 1.30(95%CI 0.77-2.22; p = 0.33,I2 = 0%)]。EUS-GBD与复发性胆囊炎的发生率较低相关[合并OR 0.33(95%CI 0.14-0.79; p = 0.01; I2 = 0%)]。分析中的异质性较低。结论与ET-GBD相比,EUS-GBD具有更高的技术和临床成功率。尽管总体不良事件发生率在统计学上相似,但EUS-GBD的复发性胆囊炎发生率较低。因此,
更新日期:2020-04-22
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