title: Endoscopic ultrasound-guided transmural stenting for gallbladder drainage in high-risk patients with acute cholecystitis: a systematic review and pooled analysis.
abstract: Endoscopic ultrasound-guided transmural stenting for gallbladder drainage is an emerging alternative for the treatment of acute cholecystitis in high-risk surgical patients. A variety of stents have been described, including plastic stents, self-expandable metal stents (SEMSs), and lumen-apposing metal stents (LAMSs). LAMSs represent the only specifically designed stent for transmural gallbladder drainage. A systematic review was performed to evaluate the feasibility and efficacy of EUS-guided drainage (EUS-GBD) in acute cholecystitis using different types of stents.
  
  
  
  A computer-assisted literature search up to September 2015 was performed using two electronic databases, MEDLINE and EMBASE. Search terms included MeSH and non-MeSH terms relating to acute cholecystitis, gallbladder drainage, endoscopic gallbladder drainage, endoscopic ultrasound gallbladder drainage, alone or in combination. Additional articles were retrieved by hand-searching from references of relevant studies. Pooled technical success, clinical success, and adverse event rates were calculated.
  
  
  
  Twenty-one studies met the inclusion criteria, and the eligible cases were 166. The overall technical success rate, clinical success rate, and frequency of adverse events were 95.8, 93.4, and 12.0 %, respectively. The technical success rate was 100 % using plastic stents, 98.6 % using SEMSs, and 91.5 % using LAMSs. The clinical success rate was 100, 94.4, and 90.1 % after the deployment of plastic stents, SEMSs, and LAMSs, respectively. The frequency of adverse events was 18.2 % using plastic stents, 12.3 % using SEMSs, and 9.9 % using LAMSs.
  
  
  
  Among the different drainage approaches in the non-surgical management of acute cholecystitis, EUS-guided transmural stenting for gallbladder drainage appears to be feasible, safe, and effective. LAMSs seem to have high potentials in terms of efficacy and safety, although further prospective studies are needed.
authors.affiliation: Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, 20089, Rozzano, Milan, Italy. andrea.anderloni@humanitas.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Anderloni
authors.affiliation: Gastroenterology Unit, Department of Gastrointestinal Oncological Surgery, 'S. Maria del Prato' Hospital, Feltre, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Buda
authors.affiliation: Gastroenterology Unit, Department of Gastrointestinal Oncological Surgery, 'S. Maria del Prato' Hospital, Feltre, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Vieceli
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Mouen A
authors.initials: MA
authors.lastname: Khashab
authors.affiliation: Gastroenterology and Digestive Endoscopy, 'Nuovo Regina Margherita' Hospital, Rome, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Hassan
authors.affiliation: Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, 20089, Rozzano, Milan, Italy.|Humanitas University, Rozzano, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Repici
mesh_terms: D041881:Cholecystitis, Acute / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D004322:Drainage / Q000295:instrumentation*; D019160:Endosonography; D006801:Humans; D015607:Stents; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
keywords: Cholecystitis; Endoscopic ultrasonography; Gallbladder drainage; Transmural stent