ENDOSCOPIC ULTRASOUND GUIDED GALLBLADDER DRAINAGE VERSUS PERCUTANEOUS DRAINAGE IN PATIENTS WITH ACUTE CHOLECYSTITIS UNDERGOING ELECTIVE CHOLECYSTECTOMY

Abstract

Background: 

Cholecystectomy (CCY) is the gold standard treatment for acute cholecystitis. Non-surgical management of acute cholecystitis 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 versus PT-GBD.

Methods: 

A multi-center international study was conducted in patients with acute cholecystitis who underwent EUS-GBD or PT-GBD followed by an attempted or CCY between January 2018 and October 2021. Demographics, clinical characteristics), procedural details, post-procedure outcomes, surgical details and outcomes were compared.

Results: 

139 patients were included: EUS-GBD in 46 patients (27% male, mean age 74), PT-GBD in 93 patients (50% male, mean age 72). Surgical technical success was not significantly different between the two 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 to the PT-GBD group. There was no difference in the rate of conversion from laparoscopic to open CCY: 5/46 (11%) in the EUS-GBD arm and 18/93 (19%) in the PTGBD group (p value 0.2324).

Conclusions: 

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 to those who received PT-GBD. EUS-GBD should be considered an acceptable modality for gallbladder drainage and should not preclude patients from eventual CCY.