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Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
Comparison of EUS-guided endoscopic transpapillary and percutaneous gallbladder drainage for acute cholecystitis: a
Alexander Podboy1, Jacky Yuan2, Christopher Donald Stave3
1Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA.
Insights
This network meta-analysis found that endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) and percutaneous gallbladder drainage (PT-GBD) offer high technical and clinical success. EUS-GBD showed the lowest risk of recurrent cholecystitis, while ETP-GBD had the lowest mortality.
Area of Science:
- Gastroenterology
- Interventional Endoscopy
- Surgical Innovation
Background:
- Optimal gallbladder drainage (GBD) for acute cholecystitis in nonsurgical candidates remains unclear.
- Comparing percutaneous (PT-GBD), endoscopic transpapillary (ETP-GBD), and EUS-guided GBD is crucial for high-risk patients.
Purpose of the Study:
- To conduct a network meta-analysis comparing PT-GBD, ETP-GBD, and EUS-GBD for acute cholecystitis.
- To evaluate the efficacy and safety of different GBD techniques in patients unsuitable for surgery.
Main Methods:
- A comprehensive literature search identified comparative studies on GBD modalities.
- Primary outcomes included technical/clinical success and adverse events; secondary outcomes included reintervention, readmissions, recurrent cholecystitis, and mortality.
Main Results:
- Ten studies with 1267 patients (472 EUS-GBD, 493 PT-GBD, 302 ETP-GBD) were analyzed.
- EUS-GBD and PT-GBD showed high likelihoods of technical and clinical success.
- EUS-GBD had the lowest recurrent cholecystitis risk; PT-GBD had higher reintervention/readmission rates.
- ETP-GBD was associated with the lowest mortality rates.
Conclusions:
- All three GBD modalities have distinct advantages and disadvantages.
- Technique selection should be based on available expertise.
- Endoscopic GBD techniques are preferred over PT-GBD in centers with endoscopic expertise, offering improved outcomes.
Background And Aims:
The optimal method of gallbladder drainage (GBD) for acute cholecystitis in nonsurgical candidates is uncertain. The aim of the current study was to conduct a network meta-analysis comparing the 3 methods of GBD (percutaneous [PT], endoscopic transpapillary [ETP], and EUS-guided).
Methods:
A comprehensive literature search for all comparative studies assessing the efficacy of either 2 or all modalities used for treatment of acute cholecystitis in patients at high risk for cholecystectomy was performed. Primary outcomes of technical and clinical success and postprocedure adverse events were assessed. Secondary outcomes were reintervention, unplanned readmissions, recurrent cholecystitis, and mortality.
Results:
Ten studies were identified, comprising 1267 patients (472 EUS-GBD, 493 PT-GBD, and 302 ETP-GBD). In the network ranking estimate, PT-GBD and EUS-GBD had the highest likelihood of technical success (EUS-GBD vs PT-GBD vs ETP-GBD: 2.00 vs 1.02 vs 2.98) and clinical success (EUS-GBD vs PT-GBD vs ETP-GBD: 1.48 vs 1.55 vs 2.98). EUS-GBD had the lowest risk of recurrent cholecystitis (EUS-GBD vs PT-GBD vs ETP-GBD: 1.089 vs 2.02 vs 2.891). PT-GBD had the highest risk of reintervention (EUS-GBD vs PT-GBD vs ETP-GBD: 1.81 vs 2.99 vs 1.199) and unplanned readmissions (EUS-GBD vs PT-GBD vs ETP-GBD: 1.582 vs 2.944 vs 1.474), whereas ETP-GBD was associated with the lowest rates of mortality (EUS-GBD vs PT-GBD vs ETP-GBD: 2.62 vs 2.09 vs 1.29).
Conclusions:
The 3 modalities of GBD have their respective advantages and disadvantages. Selection of technique will depend on available expertise. In centers with expertise in endoscopic GBD, the techniques are preferred over PT-GBD with improved outcomes. (Clinical trial registration number: CRD42020181972.).
