急性胆嚢炎に対する3つの胆嚢ドレナージ法の比較：ネットワークメタアナリシスを伴う系統的レビュー
Lingbo Hu1,2, Yongfu Xu1,2, Aidong Wang1,2
1Department of Hepatopancreatobiliary Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China.
Background:
The effectiveness of endoscopic transpapillary gallbladder drainage (ETGBD), percutaneous gallbladder drainage (PTGBD), and endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) for treating acute cholecystitis in individuals with elevated surgical risk is not yet thoroughly evaluated.
Methods:
The clinical success, technical success, and rates of adverse events for these three therapies were assessed using a random-effects model in a network meta-analysis of 2254 patients from 17 trials. We computed risk ratios (RR), 95% confidence intervals (CI), and standard mean differences (SMD), and treatments were ranked using P-scores.
Results:
PTGBD and EUS-GBD demonstrated superior technical success rates compared to ETGBD (ETGBD vs. EUS-GBD: 95% CI: 0.80-0.88, RR = 0.85; ETGBD vs. PTGBD: 95% CI: 0.79-0.86, RR = 0.83). Similarly, PTGBD and EUS-GBD achieved greater rates of clinical success than ETGBD (ETGBD vs. EUS-GBD: 95% CI: 0.75-0.86, RR = 0.81; ETGBD vs. PTGBD: 95% CI: 0.78-0.90, RR = 0.83). Procedure-related adverse effects did not differ among these three modalities. Based on ranking estimates, although EUS-GBD had the smallest likelihood of adverse events and was predicted to provide maximum clinical success, the highest technical success was probably anticipated from PTGBD.
Conclusion:
Endoscopic gallbladder drainage (EUS-GBD or ETGBD) is a preferred first-line option in centers with advanced endoscopic expertise. PTGBD remains a valuable alternative when such expertise is not available.
