729 EUS-GUIDED GALLBLADDER DRAINAGE VERSUS LAPAROSCOPIC CHOLECYSTECTOMY FOR ACUTE CHOLECYSTITIS. A PROPENSITY SCORE ANALYSIS

Abstract

EUS-guided gallbladder (EUS-GBD) is an effective and safe alternative to percutaneous drainage (PT-GBD) for acute cholecystitis. The procedure has been shown by meta-analysis to be associated with lower rates of post-procedure adverse events, shorter hospital stays, and fewer reinterventions and readmissions. However, how the procedure compares to laparoscopic cholecystectomy is unknown. The aim of the current study is to compare the long-term outcomes of EUS-GBD with laparoscopic cholecystectomy (LC) for acute cholecystitis using propensity score matching. This was retrospective study of all patients admitted for acute cholecystitis between 2012 to 2018 in the Prince of Wales Hospital in Hong Kong. Consecutive patients that received EUS-GBD or LC were included. Since patients that were included for EUS-GBD were at very-high risk for cholecystectomy, to make the two groups more comparable, they were matched for age, sex and age-adjusted charlson score using propensity score matching. Outcome measurements included 30-day adverse events, mortality, recurrent cholecystitis, recurrent biliary events, reinterventions and readmissions. During the study period, a total of 144 patients were identified and after propensity score matching, 62 patients were selected (31 EUS-GBD vs 31 LC). There were no statistically significant differences in the background demographics (Table 1). The technical success rates (100% vs 100%, P = 1), clinical success rates (90.3% vs 100%, P = 0.238) and mean (S.D.) lengths of hospital stays [6.6 (8.0) vs 5.9 (3.5), P = 0.169] were similar between the groups. The 30 adverse events [5 (16.1%) vs 5 (16.1%), P = 1] and mortality rates [3 (9.7%) vs 0 (0%), P = 0.238] were similar. None of the patients in the LC group required conversion to open surgery. The rates of recurrent biliary events [4 (12.9%) vs 3 (9.7%), P = 1], re-interventions [5 (16.1%) vs 3 (9.7%), P = 0.707] and unplanned readmissions [4 (12.9%) vs 3 (9.7%), P = 1] were also similar. Most of the patients with recurrent biliary events were due to common bile duct stones that required ERCP. One patient in the EUS-GBD group had recurrent acute cholecystitis. The duration of follow-up was significantly longer in the EUS-GBD group [561.9 (470.3) vs 278.5 (364.5), P = 0.003]. The outcomes of EUS-GBD for acute cholecystitis were comparable to LC in the longer term with acceptable rates of recurrent acute cholecystitis. This suggests that the procedure can be an alternative to LC in a selected group of surgically fit patients.Figure 1A) X-ray imaging of EUS-GBD after stenting. B) Operative photo of laparoscopic cholecystectomy.View Large Image Figure ViewerDownload Hi-res image Download (PPT)