Comparable efficacy of endoscopic transpapillary gallbladder drainage and percutaneous transhepatic gallbladder drainage in acute cholecystitis

Abstract

Background and study aims Although endoscopic transpapillary gallbladder drainage (ETGBD) is reportedly useful in patients who have acute cholecystitis, its efficacy has not been compared to that of percutaneous transhepatic gallbladder drainage (PTGBD). We retrospectively compared the efficacy and safety of ETGBD and PTGBD in patients with acute cholecystitis. Patients and methods We studied 75 patients who required gallbladder drainage for acute cholecystitis between January 2014 and December 2016. Using propensity score matching analysis, we compared the clinical efficacy and length of hospitalization in patients successfully treated with ETGBD and PTGBD. Moreover, we assessed the predictive factors for hospitalization period < 30 days using multivariate analysis. Results ETGBD and PTGBD were successfully performed in 33 patients (77 %) and 42 patients (100 %) ( P < 0.001). Twenty-seven matched pairs were obtained after propensity score matching analysis. No significant differences were observed between patients treated with ETGBD and those treated with PTGBD with respect to improvement in white blood cell count and serum C-reactive protein level. The length of hospitalization in patients treated with ETGBD was significantly shorter than in those treated with PTGBD regardless of the need for surgery. Multivariate logistic regression analysis revealed ETGBD (odds ratio, 7.07; 95 % confidence interval 2.22 – 22.46) and surgery (odds ratio 0.26; 95 % confidence interval 0.09 – 0.79) as independent factors associated with hospitalization period. There were no significant differences in occurrence of complications in ETGBD and PTGBD procedure. Conclusions ETGBD was shown to be as useful as PTGBD for treatment of acute cholecystitis and was associated with shorter hospitalization period. ETGBD can be an alternative treatment option for acute cholecystitis at times when PTGBD is not possible.

Endoscopic therapies for gallbladder drainage

“…Two retrospective studies directly compared PC with ET-GBD for treatment of acute cholecystitis (Table 2). 47,48 One study demonstrated similar technical success rates, whereas the other noted a higher rate with PC (100% PC vs 77% ET-GBD, P Z .004). 47 Both studies showed a higher absolute short-term rate of AEs with ET-GBD compared with PC, but the differences were not statistically significant (4.8% PC vs 12.1% ET-GBD, P Z .20; PC 4.8% vs ET-GBD 8.2%, P Z .08).…”

“…47,48 One study demonstrated similar technical success rates, whereas the other noted a higher rate with PC (100% PC vs 77% ET-GBD, P Z .004). 47 Both studies showed a higher absolute short-term rate of AEs with ET-GBD compared with PC, but the differences were not statistically significant (4.8% PC vs 12.1% ET-GBD, P Z .20; PC 4.8% vs ET-GBD 8.2%, P Z .08). 47,48 Long-term followup (median up to 485 days) demonstrated a higher rate of recurrent cholecystitis (17.2% PC group vs 0% ET-GBD group, P Z .04) and increased length of hospitalization with PC.…”

Early laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for acute cholecystitis

“…LC remains a challenge in patients with AC because LC may increase the possibility of conversion to OC. The incidence of conversion to OC varies from 11 to 28%, compared with < 5% in LC for chronic cholecystitis [13][14][15] . Twelve patients in our study were converted to OC, which is a similar rate to that in previous reports.…”

Validation of Tokyo Guideline 2013 as Treatment of Acute Cholecystitis by Real World Data

“…There were no differences between PTGBD and ETGBD in the improvement of WBC count and serum C-reactive protein level. In cases where PTGBD is not possible, ETGBD can be an alternative treatment option [16] for acute cholecystitis. For grade II acute cholecystitis (when antibiotics alone and general supportive care failed), the TG2013 strongly recommends surgical intervention, for example, cholecystectomy (Fig.…”