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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

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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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Funding

Dr. Andrew Ross is a consultant for Boston Scientific. Dr. Richard Kozarek receives research funding from Boston Scientific with remittance to the clinic.

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Author notes

  1. Rajesh Krishnamoorthi and Mahendran Jayaraj share co-1st authorship.

Authors and Affiliations

  1. Digestive Diseases Institute, Virginia Mason Medical Center, Seattle, WA, USA

    Rajesh Krishnamoorthi, Joanna Law, Michael Larsen, Andrew Ross, Richard Kozarek & Shayan Irani

  2. University of Nevada Las Vegas School of Medicine, Las Vegas, NV, USA

    Mahendran Jayaraj

  3. University of Kansas Medical Center, Kansas City, KS, USA

    Viveksandeep Thoguluva Chandrasekar

  4. Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA

    Dhruv Singh

  5. Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, 1100 Ninth Avenue, Seattle, WA, 98101, USA

    Rajesh Krishnamoorthi

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  1. Rajesh Krishnamoorthi
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Contributions

Manuscript inception: RK, MJ; Data acquisition and statistical analysis: RK, MJ,VST, DS; Drafting of manuscript: RK, MJ, VST, DS; Critical revision and final approval: RK, MJ, VST, DS, JL, AR, RK, SI.

Corresponding author

Correspondence to Rajesh Krishnamoorthi.

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Disclosures

Drs. Rajesh Krishnamoorthi, Mahendran Jayaraj, Vivek Sandeep Thoguluvachandrasekar, Dhruv Singh, Joanna Law, Michael Larsen and Shayan Irani have no conflicts of interest or financial ties to disclose.

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Electronic supplementary material

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Supplementary file1 (JPG 45 kb). Supplementary Figure 1: Forest plot for perforations in EUSGBD vs ETGBD

Supplementary file2 (JPG 44 kb). Supplementary Figure 2: Forest plot for Bleeding in EUSGBD vs ETGBD

Supplementary file3 (JPG 42 kb). Supplementary Figure 3: Forest plot for Bile Leak in EUSGBD vs ETGBD

Supplementary file4 (JPG 41 kb). Supplementary Figure 4: Forest plot for pain in EUSGBD vs ETGBD

Supplementary file5 (JPG 41 kb). Supplementary Figure 5: Forest plot for Stent Migration in EUSGBD vs ETGBD

464_2020_7409_MOESM6_ESM.jpg

Supplementary file6 (JPG 39 kb). Supplementary Figure 6: Forest plot for technical success in EUSGBD using LAMS vs ETGBD

Supplementary file7 (JPG 39 kb). Supplementary Figure 7: Forest plot for clinical success in EUSGBD using LAMS vs ETGBD

464_2020_7409_MOESM8_ESM.jpg

Supplementary file8 (JPG 37 kb). Supplementary Figure 8: Forest plot for overall adverse events in EUSGBD using LAMS vs ETGBD

Supplementary file9 (DOCX 16 kb)

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Krishnamoorthi, R., Jayaraj, M., Thoguluva Chandrasekar, V. et al. EUS-guided versus endoscopic transpapillary gallbladder drainage in high-risk surgical patients with acute cholecystitis: a systematic review and meta-analysis. Surg Endosc 34, 1904–1913 (2020). https://doi.org/10.1007/s00464-020-07409-7

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  • DOI: https://doi.org/10.1007/s00464-020-07409-7

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