EUS-guided gallbladder drainage versus laparoscopic cholecystectomy for acute cholecystitis: a propensity score analysis with 1-year follow-up data

Abstract

EUS-guided gallbladder drainage (EUS-GBD) is a safe alternative to percutaneous cholecystostomy (PT-GBD) for acute cholecystitis. How the procedure compares with laparoscopic cholecystectomy (LC) is uncertain. The aim of the current study is to compare the outcomes of EUS-GBD with LC for acute cholecystitis. This was propensity score analysis of all patients admitted for acute cholecystitis between 2012 and 2018. Consecutive patients who received EUS-GBD or LC were included. Patients were matched for age, sex, and age-adjusted Charlson score. Outcome measurements included 30-day adverse events, mortality, recurrent cholecystitis, recurrent biliary events, reinterventions, and readmissions. During the study period, 60 patients were selected (30 EUS-GBD vs 30 LC) after propensity score matching. Technical success rates (100% vs 100%), clinical success rates (93.3% vs 100%, P= 1), lengths of hospital stay (6.8 [8.1] vs 5.5 [2.7], P= 1), 30-day adverse events (4 [13.3%] vs 4 [13.3%], P= 1), and mortality rates (2 [6.7%] vs 0 [0%], P= .492) were similar. The rates of recurrent biliary events (3 [10%] vs 3 [10%], P= .784), reinterventions (4 [13.3%] vs 3 [10%], P= 1), and unplanned readmissions (3 [10%] vs 3 [10%], P= .784) in 1 year were also similar. The outcomes of EUS-GBD for acute cholecystitis were comparable with LC with acceptable rates of recurrent acute cholecystitis. These results support the role of EUS-GBD as an alternative to LC in patients who may or may not be surgically fit to undergo definitive cholecystectomy.