Percutaneous and endoscopic gallbladder drainage for acute cholecystitis: international multicenter comparative study using propensity score‐matched analysis

Abstract

Background Tokyo Guideline 2013 (TG13) proposed three drainage techniques for the treatment of acute cholecystitis. We evaluated the clinical efficacy and adverse events between percutaneous transhepatic intervention (PTGBI) including percutaneous transhepatic gallbladder drainage (PTGBD) and percutaneous transhepatic gallbladder aspiration (PTGBA) and endoscopic transpapillary gallbladder drainage (EGBD). Methods A cohort study was performed using propensity score matching to reduce treatment selection bias. This involved the analysis of collected data for 1,764 patients who underwent PTGBI and EGBD. Results Propensity score matching extracted 330 pairs of patients. The difference in the clinical success rate within 3 days between PTGBI and EGBD were 62.5% and 69.8%, respectively (P = 0.085). The differences in the suboptimal clinical success rates within 7 days between PTGBI and EGBD were 87.6% and 89.2% (P = 0.579). The differences in the complication rate between PTGBI and EGBD were 4.8% and 8.2% (P = 0.083). The differences in the complication rate among PTGBD, PTGBA and EGBD were 5.6%, 1.6% and 8.2% (P = 0.11). Median required days of PTGBD (3.0 days) was significantly longer than those of PTGBA and EGBD (1.5 and 2.0 days, respectively) (P = 0.001). Conclusion The current study showed the PTGBI showed similar clinical efficacy compared with EGBD without significant discrepancy of complication rate for the treatment of acute cholecystitis.

Prospective multicenter international study on the outcomes of a newly developed self‐approximating lumen‐apposing metallic stent for drainage of pancreatic fluid collections and endoscopic necrosectomy

“…The advent of LAMS has made tremendous impact on the performance of EUS‐guided anastomosis to the bile ducts, gallbladder and the gastrointestinal tract . However, whether the use of LAMS improves outcomes for drainage of PFC is controversial.…”

“…The advent of LAMS has made tremendous impact on the performance of EUS-guided anastomosis to the bile ducts, gallbladder and the gastrointestinal tract. 1,[7][8][9][10][11][12][13][14] However, whether the use of LAMS improves outcomes for drainage of PFC is controversial. In theory, LAMS provides a largediameter stent for rapid drainage of the collection.…”

Tokyo Guidelines 2018: management strategies for gallbladder drainage in patients with acute cholecystitis (with videos)

“…Therefore, PTGBA should not be recommended as a standard procedure for all patients with AC. However, the latest international multicenter study (OS) showed that the clinical success rate within 3 days of PTGBA was significantly higher than that of PTGBD and EGBS, although there was no significant difference within 7 days. Also, the complication rate of PTGBA was lower than that of PTGBD and EGBS.…”

Hybrid procedure combining endoscopic gallbladder lavage and internal drainage with elective cholecystectomy for acute cholecystitis: A prospective pilot study (The BLADE study)

“…However, carrying out the procedure may be unfavorable in patients in generally poor health or with high surgical risk. In such cases, delayed elective cholecystectomy is considered after decompression of the swollen gallbladder by percutaneous or endoscopic transpapillary drainage . Percutaneous transhepatic gallbladder drainage (PTGBD) is the most common procedure for non‐surgical gallbladder drainage.…”

“…In such cases, delayed elective cholecystectomy is considered after decompression of the swollen gallbladder by percutaneous or endoscopic transpapillary drainage. [4][5][6][7][8] Percutaneous transhepatic gallbladder drainage (PTGBD)…”