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.

中文翻译：

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EUS引导胆囊引流与腹腔镜胆囊切除术治疗急性胆囊炎：倾向评分分析，并随访1年

背景和目标

EUS引导的胆囊引流术（EUS-GBD）是治疗急性胆囊炎的经皮胆囊造口术（PT-GBD）的安全替代方法。该手术与腹腔镜胆囊切除术（LC）相比如何还不确定。本研究的目的是比较EUS-GBD与LC治疗急性胆囊炎的疗效。

方法

这是对2012年至2018年间所有接受急性胆囊炎的患者的倾向评分分析。包括接受EUS-GBD或LC的连续患者。根据年龄，性别和年龄调整后的Charlson评分对患者进行匹配。结果测量包括30天不良事件，死亡率，胆囊炎复发，胆道复发，再次干预和再次入院。

结果

在研究期间，倾向评分匹配后选择了60例患者（30例EUS-GBD与30例LC）。技术成功率（100％对100％），临床成功率（93.3％对100％，P  = 1），住院时间（6.8 [8.1]对5.5 [2.7]，P  = 1），30天不良反应事件（4 [13.3％] vs 4 [13.3％]，P  = 1）和死亡率（2 [6.7％] vs 0 [0％]，P  = .492）相似。复发性胆道事件的发生率（3 [10％] vs 3 [10％]，P  = .784），再次干预（4 [13.3％] vs 3 [10％]，P  = 1）和计划外再入院的发生率（3 [ 1年中10％对3 [10％，P  = .784）也相似。

结论

EUS-GBD治疗急性胆囊炎的结果与LC相当，复发性急性胆囊炎的发生率可以接受。这些结果支持EUS-GBD在可能适合或可能不适合进行最终性胆囊切除术的患者中替代LC的作用。