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Percutaneous and endoscopic gallbladder drainage for acute cholecystitis: international multicenter comparative study
Takao Itoi1, Tadahiro Takada2, Tsann-Long Hwang3
1Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan.
Insights
Percutaneous transhepatic intervention (PTGBI) and endoscopic transpapillary gallbladder drainage (EGBD) show similar clinical efficacy for acute cholecystitis. PTGBI demonstrated comparable complication rates to EGBD, supporting its use.
Area of Science:
- Gastroenterology
- Interventional Radiology
- Surgical Oncology
Background:
- Tokyo Guideline 2013 (TG13) recommends three drainage techniques for acute cholecystitis.
- Percutaneous transhepatic intervention (PTGBI), encompassing PTGBD and PTGBA, and endoscopic transpapillary gallbladder drainage (EGBD) are key treatments.
Purpose of the Study:
- To compare the clinical efficacy and adverse events of PTGBI versus EGBD in treating acute cholecystitis.
- To evaluate the effectiveness of different PTGBI techniques (PTGBD, PTGBA) against EGBD.
Main Methods:
- A propensity score-matched cohort study analyzed 1,764 patients undergoing PTGBI or EGBD.
- 330 matched pairs were extracted to minimize treatment selection bias.
Main Results:
- Clinical success rates within 3 and 7 days were similar between PTGBI (62.5%, 87.6%) and EGBD (69.8%, 89.2%).
- Complication rates were comparable (PTGBI 4.8% vs. EGBD 8.2%). PTGBD (5.6%) was longer than PTGBA (1.6%) and EGBD (8.2%).
- PTGBD required significantly more days (3.0) compared to PTGBA (1.5) and EGBD (2.0).
Conclusions:
- PTGBI offers comparable clinical efficacy to EGBD for acute cholecystitis.
- No significant difference in complication rates was observed between PTGBI and EGBD.
- PTGBI is a viable alternative to EGBD for acute cholecystitis management.
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.