Endoscopic Ultrasound-Guided versus Endoscopic Transpapillary Gallbladder Drainage in High Surgical Risk Patients with Acute Cholecystitis: An Updated Systematic Review and Meta-Analysis.
Abstract
Background
Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) and endoscopic transpapillary gallbladder drainage (ET-GBD) are alternatives for high surgical-risk patients with acute cholecystitis (AC). Their comparative efficacy and safety remain uncertain.
Methods
Studies comparing EUS-GBD and ET-GBD in high surgical-risk AC patients were pooled using random-effects models, with subgroup analyses by stent type. Primary outcomes were technical and clinical success; secondary outcomes included recurrence of cholecystitis, post-procedure cholangitis, procedural time and adverse events (AEs). Trial sequential analysis (TSA) assessed conclusiveness.
Results
Nine studies (1,479 patients) were included. EUS-GBD achieved higher technical success (odds ratio [OR], 4.34; 95% confidence interval [CI], 2.18-8.65) and clinical success (OR, 2.79; 95% CI, 1.34-5.80), with lower recurrence of cholecystitis (OR, 0.34; 95% CI, 0.18-0.66) and post-procedure cholangitis (OR, 0.22; 95% CI, 0.06-0.87). Overall AE rates were similar (OR, 1.16; 95% CI, 0.75-1.79), although bile leak was more frequent with EUS-GBD (OR, 5.90; 95% CI, 1.01-34.60). Procedural time was shorter with EUS-GBD (weighted mean difference, -13.17minutes; 95% CI, -23.64 to -2.70). Technical success favored EUS-GBD with all stent types, whereas clinical success and recurrence favored EUS-GBD with metal but not plastic stents, although subgroup differences were not significant. TSA supported the technical success and recurrence findings, but clinical success was less firmly established.
Conclusion
EUS-GBD offers superior technical and clinical success and reduces recurrence of cholecystitis and post-procedure cholangitis compared with ET-GBD in high surgical-risk AC patients. Bile leak may be more frequent. Stent-specific findings were exploratory. Prospective trials warranted to confirm these results and to evaluate cost-effectiveness.