title: Endoscopic ultrasound-guided transmural and percutaneous transhepatic gallbladder drainage are comparable for acute cholecystitis.
abstract: OBJECTIVE
  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.affiliation: Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Ji Woong
authors.initials: JW
authors.lastname: Jang
authors.forename: Sang Soo
authors.initials: SS
authors.lastname: Lee
authors.forename: Tae Jun
authors.initials: TJ
authors.lastname: Song
authors.forename: Yil Sik
authors.initials: YS
authors.lastname: Hyun
authors.forename: Do Hyun
authors.initials: DY
authors.lastname: Park
authors.forename: Dong-Wan
authors.initials: DW
authors.lastname: Seo
authors.forename: Sung-Koo
authors.initials: SK
authors.lastname: Lee
authors.forename: Myung-Hwan
authors.initials: MH
authors.lastname: Kim
authors.forename: Sung-Cheol
authors.initials: SC
authors.lastname: Yun
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D041881:Cholecystitis, Acute / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D004322:Drainage / Q000009:adverse effects / Q000379:methods*; D019160:Endosonography; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011446:Prospective Studies; D056910:Republic of Korea; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome