883 EUS-Guided Gallbladder Drainage versus Endoscopic Trans-Papillary Gallbladder Drainage for High Risk Surgical Patients With Acute Cholecystitis: A Systematic Review and Meta-Analysis

Abstract

INTRODUCTION: In patients with acute cholecystitis who were deemed high risk for cholecystectomy, percutaneous cholecystostomy (PC) was historically performed for decompression of the gallbladder. There are several limitations associated with PC. Endoscopic gallbladder drainage [Endoscopic trans-papillary gallbladder drainage (ET-GBD) via ERCP and EUS-guided gallbladder drainage (EUS-GBD)] is an alternative to PC. We performed a systematic review and meta-analysis to compare the outcomes between the two endoscopic techniques (EUS-GBD vs ET-GBD). METHODS: We performed a systematic search of multiple databases through May 2019 to identify studies that compared outcomes of EUS-GBD versus ET-GBD in management of acute cholecystitis in high risk surgical patients. Pooled odds ratios (OR) of technical success, clinical success and adverse events between EUS-GBD and ET-GBD groups were calculated. RESULTS: Five comparative studies with a total of 861 patients; were included in the analysis. The pooled OR for technical success of EUS-GBD in comparison to ET-GBD was 5.22 (95% CI: 2.03-13.44; P = 0.01; I2 = 20%). The pooled OR for clinical success (EUS-GBD vs ET-GBD) in intention-to-treat analysis was 4.16 (95% CI: 2.00-8.66; P = 0.001; I2 = 19%) and per-protocol analysis was 1.81 (95% CI: 0.80-4.09; P = 0.15; I2 =0%). The pooled OR for overall acute adverse events (EUS-GBD vs ET-GBD) was 1.32 (95% CI: 0.78 -2.25; P = 0.31, I2 = 0%). The pooled OR for perforation and pancreatitis (EUS-GBD vs ETGBD) were 1.98 (95% CI: 0.32-12.29) and 0.19 (95% CI: 0.03-0.99) respectively. The pooled OR for recurrent cholecystitis (EUS-GBD vs ETGBD) was 0.33 (95% CI: 0.13-0.82). There was minimal heterogeneity in the analysis. CONCLUSION: EUS-GBD is associated with higher rate of technical and clinical success compared to ET-GBD. While the rate of overall acute adverse events are statistically similar between the two techniques, EUS-GBD is associated with lower rate of recurrent cholecystitis. In centers with expertise in EUS, EUS-GBD could be considered as first-line treatment in carefully selected patients.