Endoscopic Ultrasound-Guided Gallbladder Drainage versus Percutaneous Gallbladder Drainage for Acute Cholecystitis: A Systematic Review and Meta-Analysis

Boregowda, Umesha; Chen, Millie; Saligram, Shreyas

doi:10.3390/diagnostics13040657

Cited by 19 publications

(11 citation statements)

References 28 publications

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“…This is similar with another study using the NIS database from 2005 to 2014, which showed that patients undergoing percutaneous drainage for acute cholecystitis were signi cantly older compared to those undergoing cholecystectomy or no intervention [29]. However, various meta-analyses analyzing different drainage modalities for cases of acute cholecystitis and malignant obstruction have shown no correlation with age [30,31].…”

Section: Discussionsupporting

confidence: 84%

Title: Evaluating Nasobiliary and Stent Drainage in Acute Cholecystitis and Cholangitis: Insights from a National Inpatient Survey

Poudel,

Adhikari,

Poudel

et al. 2024

Preprint

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Background: Acute cholecystitis is typically managed with cholecystectomy. However, in patients with underlying co-morbidities who are not suitable for surgery, drainage procedures are recommended. Traditionally, these procedures have been performed percutaneously, but endoscopic techniques have gained popularity in recent years due to their physiological approach and lower complication rates. Aims: This study aims to compare endoscopic modalities of drainage (nasobiliary and internal drainage with stenting) in patients with acute cholecystitis and acute cholangitis. We also compared percutaneous drainage with endoscopic retrograde drainage procedures. Methods: We analyzed the National Inpatient Sample (NIS) database (2016-2020) to compare outcomes of acute cholecystitis and cholangitis patients undergoing endoscopic nasobiliary drainage and stent placement. Differences in outcomes between percutaneous and various endoscopic drainages were highlighted. Statistical significance was assessed using χ² and t-tests for categorical and continuous data respectively, with P<0.05 considered significant. Multivariate analyses were performed to assess study outcomes and adverse events for each procedure. Results: Patients subjected to nasobiliary drainage exhibited a higher mean age compared to those undergoing internal drainage (68.56 +/- 1.84 years vs 64.62 +/- 0.39 years, p-value < 0.05). Both groups shared similar demographic parameters and comorbidities. Internal drainage with stenting correlated with elevated incidences of acute pancreatitis (14.68% vs 13.04%, p-value <0.05) and intestinal perforation (4.24% vs 2.17%, p-value <0.05) compared to nasobiliary drainage. Conversely, nasobiliary drainage was associated with increased occurrences of bleeding (2.17% vs 0.98%, p-value < 0.05) and ileus (10.87% vs 5.22%, p-value < 0.05). Additionally, internal drainage with stenting exhibited a higher rate of subsequent cholecystectomy compared to nasobiliary drainage (3.20% vs 2.17%, p-value < 0.05). Percutaneous drainage predominated among older individuals (70.36 +/- 0.16 years vs 64.15 +/-0.35, p-value < 0.05). The adjusted odds ratio for mortality for percutaneous drainage versus endoscopic drainage was (5.15 +/- 0.88 vs 0.2 +/- 0.03, p-value < 0.05). Those undergoing endoscopic drainage demonstrated a substantially higher rate of subsequent cholecystectomy (26.50% vs 0.24%, p-value < 0.05). Conclusion: Patients undergoing nasobiliary or internal drainage with stent shared similar demographic characteristics and comorbidities. Internal drainage with stenting correlated with a heightened risk of acute pancreatitis and intestinal perforation, whereas bleeding and ileus were more prevalent with nasobiliary drainage. Moreover, internal drainage with stent was associated with a higher incidence of subsequent cholecystectomy.

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Section: Discussionsupporting

confidence: 84%

Title: Evaluating Nasobiliary and Stent Drainage in Acute Cholecystitis and Cholangitis: Insights from a National Inpatient Survey

Poudel,

Adhikari,

Poudel

et al. 2024

Preprint

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Section: Acute Cholecystitismentioning

confidence: 99%

“…In the recent meta-analysis, EUS-GBD procedure was compared with PT-GBD, where the pooled technical success was 89.9% [95% confidence interval (CI): 0.87-0.92] and 87.5% (95%CI: 0.85-0.90), respectively[ 16 ]. Clinical success in EUS-GBD group was observed in 97% (95%CI: 0.95-0.98) of patients, and in 94.1% (95%CI: 0.92-0.96) of the patients treated with PT-GBD[ 16 ]. Despite that above mentioned results for AC treatment were almost comparable, differed significantly when AEs rate was assessed, ranging 14.6% and nearly 30% for EUS-GBD and PT-GBD, respectively.…”

Section: Acute Cholecystitismentioning

confidence: 99%

Use of endoscopic ultrasound-guided gallbladder drainage as a rescue approach in cases of unsuccessful biliary drainage

Fugazza,

Khalaf,

Pawlak

et al. 2024

World J Gastroenterol

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This narrative review provides an overview of the utilization of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) as a salvage approach in cases of unsuccessful conventional management. EUS-GBD is a minimally invasive and effective technique for drainage in patients with acute cholecystitis with high risk of surgery. The procedure has demonstrated impressive technical and clinical success rates with low rates of adverse events, making it a safe and effective option for appropriate candidates. Furthermore, EUS-GBD can also serve as a rescue option for patients who have failed endoscopic retrograde cholangiopancreatography or EUS biliary drainage for relief of jaundice in malignant biliary stricture. However, patient selection is critical for the success of EUS-GBD, and proper patient selection and risk assessment are important to ensure the safety and efficacy of the procedure. As the field continues to evolve and mature, ongoing research will further refine our understanding of the benefits and limitations of EUS-GBD, ultimately leading to improved outcomes for patients.

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confidence: 99%

Rescuing maldeployment of lumen‐apposing metal stent for the management of acute cholecystitis

Chung

Chen

2023

Digestive Endoscopy

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Rescuing maldeployment of lumen-apposing metal stent for the management of acute cholecystitisEndoscopic ultrasound (EUS)-guided transmural drainage with a lumen-apposing metal stent (LAMS) has expanded its indications for off-label use including gallbladder drainage (GBD). [1][2][3][4] Maldeployment is one of the immediate complications. 1,5 Here we present a surgically unfit 85-year-old woman with acute cholecystitis (Fig. 1).She underwent EUS-GBD with a LAMS (Hot AXIOS, 15 9 10 mm; Boston Scientific, Marlborough, MA, USA). Deployment was performed under EUS guidance. No bile drainage was noticed after deployment and fluoroscopy found that the distal flange was deployed between the duodenum and gallbladder (Fig. 2a). We rapidly advanced a guidewire (0.035, VisiGlide 2; Olympus, Tokyo, Japan) through LAMS. Fortunately, it went through the puncture defect of the gallbladder with looping under fluoroscopy followed by successful double pigtail plastic stent (DPS) insertion (Advanix biliary stents; Boston Scientific; Fig. 2b). The critical point was to block the lumen of LAMS to prevent complications from a perforated duodenum since the distal flange was in the retroperitoneum rather than in the gallbladder. Three 10F-3 cm and two 7F-3 cm DPS, which had a total diameter of about 15 mm (Fig. 2c,d), were inserted. We did not consider the following: (i) tubular self-expandable metal stent in LAMS due to possible migration; (ii) repositioning of the same LAMS due to a higher failure rate; or (iii) LAMS-in-LAMS due to cost issues. She has lived uneventfully for 6 months. Long-term indwelling LAMS with coaxial DPS was considered. We have learned from this case that distal flange deployment under both EUS and fluoroscopy guidance is useful, because EUS imaging might be affected by acoustic shadow from stones.

show abstract

Endoscopic Ultrasound-Guided Gallbladder Drainage versus Percutaneous Gallbladder Drainage for Acute Cholecystitis: A Systematic Review and Meta-Analysis

Cited by 19 publications

References 28 publications

Title: Evaluating Nasobiliary and Stent Drainage in Acute Cholecystitis and Cholangitis: Insights from a National Inpatient Survey

Title: Evaluating Nasobiliary and Stent Drainage in Acute Cholecystitis and Cholangitis: Insights from a National Inpatient Survey

Use of endoscopic ultrasound-guided gallbladder drainage as a rescue approach in cases of unsuccessful biliary drainage

Rescuing maldeployment of lumen‐apposing metal stent for the management of acute cholecystitis

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