Endoscopic Approaches to Drainage for Acute Cholecystitis Are Optimal in Nonoperative Patients

Endoscopic Approaches to Drainage for Acute Cholecystitis Are Optimal in Nonoperative Patients

Bret T. Petersen, MD, MASGE, reviewing Podboy A, et al. Gastrointest Endosc 2020 Sep 24.

Gallbladder removal or drainage is a key component of treatment for acute cholecystitis. When the risk of urgent cholecystectomy is considered prohibitive, the optimal alternative therapy is uncertain. The options include drainage via the traditional percutaneous route (PERC-D), ERCP-guided transpapillary stenting (ERC-D), or EUS-guided transduodenal stenting (EUS-D). The authors of this network meta-analysis identified 10 published studies comparing 2 or all 3 of the available drainage approaches among 1267 patients. PERC-D and EUS-D had the highest likelihood of technical and clinical success, whereas ERC-D had the lowest mortality rate, EUS-D had the lowest risk of recurrent cholecystitis in the absence of subsequent surgery, and PERC-D had the highest risk for required reintervention.

Bret T. Petersen, MD, FASGE

COMMENT

As noted by the authors, all available routes can be efficacious, though success and risks vary by technique, pathology, and skill set. The availability of each approach is highly varied among centers, but when endoscopic expertise is available, the EUS- and ERCP-guided approaches appear preferable to the percutaneous route.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATION(S)

Podboy A, Yuan J, Stave CD, Chan SM, Hwang J, Teoh AYB. Comparison of EUS-guided endoscopic transpapillary and percutaneous gallbladder drainage for acute cholecystitis:  a systematic review with network meta-analysis. Gastrointest Endosc 2020 Sep 24. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2020.09.040)

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