Endoscopic Ultrasound-Guided Gallbladder Drainage Versus Percutaneous Drainage in Patients With Acute Cholecystitis Undergoing Elective Cholecystectomy

Abstract

INTRODUCTION: Cholecystectomy (CCY) is the gold standard treatment of acute cholecystitis (AC). Nonsurgical management of AC includes percutaneous transhepatic gallbladder drainage (PT-GBD) and endoscopic ultrasound-guided gallbladder drainage (EUS-GBD). This study aims to compare outcomes of patients who undergo CCY after having received EUS-GBD vs PT-GBD. METHODS: A multicenter international study was conducted in patients with AC who underwent EUS-GBD or PT-GBD, followed by an attempted CCY, between January 2018 and October 2021. Demographics, clinical characteristics, procedural details, postprocedure outcomes, and surgical details and outcomes were compared. RESULTS: One hundred thirty-nine patients were included: EUS-GBD in 46 patients (27% male, mean age 74 years) and PT-GBD in 93 patients (50% male, mean age 72 years). Surgical technical success was not significantly different between the 2 groups. In the EUS-GBD group, there was decreased operative time (84.2 vs 165.4 minutes, P < 0.00001), time to symptom resolution (4.2 vs 6.3 days, P = 0.005), and length of stay (5.4 vs 12.3 days, P = 0.001) compared with the PT-GBD group. There was no difference in the rate of conversion from laparoscopic to open CCY: 5 of 46 (11%) in the EUS-GBD arm and 18 of 93 (19%) in the PT-GBD group (P value 0.2324). DISCUSSION: Patients who received EUS-GBD had a significantly shorter interval between gallbladder drainage and CCY, shorter surgical procedure times, and shorter length of stay for the CCY compared with those who received PT-GBD. EUS-GBD should be considered an acceptable modality for gallbladder drainage and should not preclude patients from eventual CCY.

Global, regional, and national burden of gallbladder and biliary diseases from 1990 to 2019

“…However, nonsurgical management includes endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) and percutaneous transhepatic gallbladder drainage (PT-GBD) was also a choice for the treatment of acute cholecystitis. However, in some low-SDI regions, they can only conduct open cholecystectomy and cannot performed less invasive LC, EUS-GBD, and PT-GBD due to limited medical resources, which may lead to higher prevalence and YLDs[ 27 , 28 ]. Furthermore, we found that high-income Asia Pacific countries, including Japan, have a high ASIR of GABD, whereas the least developed regions such as the sub-Saharan Africa region ( e.g., Somalia and Guinea) had lower ASIR in 2019.…”

EUS-guided gallbladder drainage in acute cholecystitis: long-term problems with surgical approach

“…In one recent retrospective study comparing outcomes among patients undergoing cholecystectomy after EUS-GBD or percutaneous cholecystostomy, 35% of the EUS-GBD cohort required open or conversion to open cholecystectomy; in two patients the surgery was aborted due to presence of significant inflammation. 9 In our opinion, should surgery be contemplated in this patient cohort, it is best performed by expert surgeons for optimal outcomes.…”

“… 8 Should cholecystectomy be undertaken, some authors recommend removal of LAMS prior to surgery with endoscopic closure of the fistula tract. 9 While EUS-GBD can be undertaken by adopting either a transgastric or transduodenal route, the transgastric approach provides the advantage of easier closure of the fistula endoscopically after LAMS removal or intraoperatively where surgical mobilisation and repair are relatively easier to perform. In one recent retrospective study comparing outcomes among patients undergoing cholecystectomy after EUS-GBD or percutaneous cholecystostomy, 35% of the EUS-GBD cohort required open or conversion to open cholecystectomy; in two patients the surgery was aborted due to presence of significant inflammation.…”

Endoscopic Gallbladder Drainage: A Comprehensive Review on Indications, Techniques, and Future Perspectives

“…The role of EUS-GBD as a bridge-to-surgery is still undefined, due to the concerns about the surgical management of the choelcystogastric or, particularly, the cholecystoduodenal fistula, that may hinder a successful laparoscopic intervention. A multicenter retrospective analysis compared the outcome of cholecystectomy after EUS-BGD (n = 46) or PGBD (n = 93) [59]. In this study, all LAMS were removed before surgery, and the fistula was closed with an over-the-scope clip (OTSC).…”

“…However, it should be noted that most of EUS-GBD had been performed transgastrically (80.4%). Despite that, about 35% of cases in the EUS-GBD group were finally managed with open cholecystectomy [59]. Recently, Bang and colleagues reported 25 cases of cholecystectomy after EUS-GBD [60].…”