Endoscopic Ultrasound-Guided Gallbladder Drainage Versus Percutaneous Drainage in Patients With Acute Cholecystitis Undergoing Elective Cholecystectomy
Amy Tyberg, Rodrigo Duarte-Chavez, Haroon Shahid, Avik Sarkar, Alexa Simon, Sardar M. Shah-Khan, Monica Gaidhane, Tayyaba F. Mohammad, John L. Nosher, Susannah S. Wise, Victoria Needham, Marin Kheng, Michael Lajin, Badal Sojitra, Bryan Wey, Shivangi Dorwat, Hameed Raina, Jaseem Ansari, Ashish Gandhi, Amol Bapaye, Sardar M. Shah-Khan, Matthew Krafft, Shyam Thakkar, Shailendra Singh, Janele R. Bane, John Nasr, David P. Lee, Prashant Kedia, Martha Arevalo-Mora, Raquel S. Del Valle, Carlos Robles‐Medranda, Miguel Puga‐Tejada, Giuseppe Vanella, José Celso Ardengh, Mohammad Bilal, Dell'Anna Giuseppe, Paolo Giorgio Arcidiacono, Michel Kahaleh
Abstract
INTRODUCTION: Cholecystectomy (CCY) is the gold standard treatment of acute cholecystitis (AC). Nonsurgical management of AC includes percutaneous transhepatic gallbladder drainage (PT-GBD) and endoscopic ultrasound-guided gallbladder drainage (EUS-GBD). This study aims to compare outcomes of patients who undergo CCY after having received EUS-GBD vs PT-GBD. METHODS: A multicenter international study was conducted in patients with AC who underwent EUS-GBD or PT-GBD, followed by an attempted CCY, between January 2018 and October 2021. Demographics, clinical characteristics, procedural details, postprocedure outcomes, and surgical details and outcomes were compared. RESULTS: One hundred thirty-nine patients were included: EUS-GBD in 46 patients (27% male, mean age 74 years) and PT-GBD in 93 patients (50% male, mean age 72 years). Surgical technical success was not significantly different between the 2 groups. In the EUS-GBD group, there was decreased operative time (84.2 vs 165.4 minutes, P < 0.00001), time to symptom resolution (4.2 vs 6.3 days, P = 0.005), and length of stay (5.4 vs 12.3 days, P = 0.001) compared with the PT-GBD group. There was no difference in the rate of conversion from laparoscopic to open CCY: 5 of 46 (11%) in the EUS-GBD arm and 18 of 93 (19%) in the PT-GBD group ( P value 0.2324). DISCUSSION: Patients who received EUS-GBD had a significantly shorter interval between gallbladder drainage and CCY, shorter surgical procedure times, and shorter length of stay for the CCY compared with those who received PT-GBD. EUS-GBD should be considered an acceptable modality for gallbladder drainage and should not preclude patients from eventual CCY.