Original articleClinical endoscopyEUS-guided gallbladder drainage versus laparoscopic cholecystectomy for acute cholecystitis: a propensity score analysis with 1-year follow-up data
Graphical abstract
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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2022, Best Practice and Research: Clinical GastroenterologyCitation Excerpt :The use of ec-LAMS in this setting has significantly improved the efficacy and safety of EUS-GBD. EUS-GBD has also been proposed as rescue biliary drainage strategy in distal MBO setting after failure of ERCP and EUS-CDS [3,72] (Fig. 4). Site of obstruction should distal to cystic duct insertion into CBD and the patency of the cystic duct are two fundamental anatomical aspects that should be carefully evaluated before considering EUS-GBD for dMBO management [12,73].
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.