Long-term outcomes of endoscopic ultrasound-guided gallbladder drainage versus insitu or ex situ percutaneous gallbladder drainage in real-world practice.

Abstract

Many studies showed better outcomes of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) when compared with percutaneous transhepatic gallbladder drainage (P-GBD) in which most tubes were left insitu. However, no studies have directly compared EUS-GBD with P-GBD after tube removal (ex situ). We compared the long-term outcomes of EUS-GBD and ex situ or insitu P-GBD in high surgical risk patients with acute cholecystitis. We reviewed the records of 182 patients (EUS-GBD, n=75; P-GBD, n=107) who underwent gallbladder drainage. The procedural outcomes, long-term outcomes, and adverse events were compared. The EUS-GBD group and the P-GBD group had similar rates of technical and clinical success. Early adverse events were less common in the EUS-GBD group (5.5% vs. 18.9%, P=0.010). The long-term outcomes were evaluated in 168 patients (EUS-GBD, n=67; P-GBD ex situ, n=84; P-GBD insitu, n=17). The rate of cholecystitis recurrence in the EUS-GBD group (6.0%) was similar to that in the P-GBD ex situ group (9.6%, P=0.422), but significantly lower than that in the P-GBD insitu group (23.5%, P=0.049). P-GBD insitu was a significant predictor of recurrent cholecystitis (hazard ratio 14.6; 95% confidence interval 2.9-72.8). The long-term recurrence rate of acute cholecystitis in patients who underwent EUS-GBD was comparable to that in patients whose P-GBD could be removed. However, patients in whom P-GBD could not be removed showed higher rates of recurrent cholecystitis than patients with EUS-GBD.