Original article
Clinical endoscopy
EUS-guided gallbladder drainage versus laparoscopic cholecystectomy for acute cholecystitis: a propensity score analysis with 1-year follow-up data

https://doi.org/10.1016/j.gie.2020.06.066Get rights and content

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.

Section snippets

Methods

This was a propensity score analysis of a retrospective database that included all patients with acute cholecystitis who received EUS-GBD or LC as a definitive management between 2012 and 2018 at the Prince of Wales Hospital in Hong Kong. During the study period, EUS-GBD was first introduced and offered to patients who were at very high risk for cholecystectomy, and LC was offered to patients who were surgical candidates in the same time period. Because the 2 groups differ significantly in

Results

During the study period, 144 patients were identified (74 EUS-GBD and 70 LC). Patients were matched by age, sex, and age-adjusted Charlson score with propensity score matching, and 60 patients were selected (30 EUS-GBD vs 30 LC). Table 1 shows the 3 parameters before and after matching. Before matching, age (P < .001) and age-adjusted Charlson scores (P < .001) were significantly different. After matching, the parameters were not significantly different.

The comparison in background demographics

Discussion

The current study is the first to compare the outcomes of EUS-GBD with LC after propensity score analysis. Although equivalence in the outcomes cannot be concluded because of lack of power, in the short term, the 30-day adverse event rate and mortality appeared to be comparable. In the longer term, recurrent biliary events and cholecystitis rates were also comparable between the groups. This suggests that EUS-GBD may reduce the risk of gallstone-related adverse events, and this may be a

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    DISCLOSURE: The following authors disclosed financial relationships: A. Y. B. Teoh: Consultant for Boston Scientific, Cook, Taewoong, and Microtech Medical. All other authors disclosed no financial relationships.

    If you would like to chat with an author of this article, you may contact Dr Teoh at [email protected].

    See CME section; p. 727.

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