Endoscopic ultrasound-guided transmural and percutaneous transhepatic gallbladder drainage are comparable for acute cholecystitis.

Abstract

BACKGROUND & AIMS:

Endoscopic ultrasound-guided transmural gallbladder drainage (EUS-GBD) is an alternative to percutaneous transhepatic gallbladder drainage (PTGBD) for patients with acute, high-risk, or advanced-stage cholecystitis who do not respond to initial medical treatment and cannot undergo emergency cholecystectomy. However, the technical feasibility, efficacy, and safety of EUS-GBD and PTGBD have not been compared.

METHODS:

Fifty-nine patients with acute cholecystitis, who did not respond to initial medical treatment and were unsuitable for an emergency cholecystectomy, were chosen randomly to undergo EUS-GBD (n = 30) or PTGBD (n = 29). The technical feasibility, efficacy, and safety of EUS-GBD and PTGBD were compared.

RESULTS:

EUS-GBD and PTGBD showed similar technical (97% [29 of 30] vs 97% [28 of 29]; 95% 1-sided confidence interval lower limit, -7%; P = .001 for noninferiority margin of 15%) and clinical (100% [29 of 29] vs 96% [27 of 28]; 95% 1-sided confidence interval lower limit, -2%; P = .0001 for noninferiority margin of 15%) success rates, and similar rates of complications (7% [2 of 30] vs 3% [1 of 29]; P = .492 in the Fisher exact test) and conversions to open cholecystectomy (9% [2 of 23] vs 12% [3 of 26]; P = .999 in the Fisher exact test). The median post-procedure pain score was significantly lower after EUS-GBD than after PTGBD (1 vs 5; P < .001 in the Mann-Whitney U test).

CONCLUSIONS:

EUS-GBD is comparable with PTGBD in terms of the technical feasibility and efficacy; there were no statistical differences in the safety. EUS-GBD is a good alternative for high-risk patients with acute cholecystitis who cannot undergo an emergency cholecystectomy.

• Authors: Ji Woong Jang, Sang Soo Lee, Tae Jun Song, Yil Sik Hyun, Do Hyun Park, Dong-Wan Seo, Sung-Koo Lee, Myung-Hwan Kim, Sung-Cheol Yun
• Journal: Gastroenterology (Gastroenterology) Vol. 142 Issue 4 Pg. 805-11 (Apr 2012) ISSN: 1528-0012 [Electronic] United States
• PMID: 22245666 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't, Video-Audio Media)
• Copyright: Copyright © 2012 AGA Institute. Published by Elsevier Inc. All rights reserved.

Topics

• Adult
• Aged
• Aged, 80 and over
• Cholecystitis, Acute (diagnostic imaging, etiology, therapy)
• Drainage (adverse effects, methods)
• Endosonography
• Feasibility Studies
• Female
• Humans
• Male
• Middle Aged
• Patient Selection
• Prospective Studies
• Republic of Korea
• Risk Assessment
• Risk Factors
• Treatment Outcome