title: Endoscopic ultrasound-guided gallbladder drainage reduces adverse events compared with percutaneous cholecystostomy in patients who are unfit for cholecystectomy.
abstract: Background and study aimThere are no data comparing endoscopic ultrasound (EUS)-guided gallbladder drainage (EGBD) with percutaneous cholecystostomy as a treatment for patients with acute cholecystitis.Patients and methodsThis was a 1 : 1 matched cohort study of all patients who were unfit for cholecystectomy and underwent EGBD or percutaneous cholecystostomy instead for the treatment of acute cholecystitis. The outcomes were matched for age, sex, and American Society of Anesthesiologists grade. Outcome measures included the technical and clinical success rates, adverse events, hospital stay, the number of unplanned admissions, and mortality.ResultsBetween November 2011 and August 2014, a total of 118 patients were included in the study (59 EGBD, 59 percutaneous cholecystostomy). Technical and clinical success rates were similar. In the EGBD group, significantly fewer patients suffered from overall adverse events (19 [32.2 %] vs. 44 [74.6 %];P< 0.001) and serious adverse events (14 [23.7 %] vs. 44 [74.6 %];P< 0.001) compared to the percutaneous cholecystostomy group. Patients in the EGBD group required fewer unplanned admissions (4 [6.8 %] vs. 42 [71.2 %];P< 0.001), which were due to problems related to the cholecystostomy tube in 95.2 %. The 30-day adverse event rates were similar between the groups (17 [28.8 %] vs. 10 [16.9 %];P= 0.13). For instance, recurrent acute cholecystitis occurred in 0 patients in the EGBD group and in 4 (6.8 %) patients in the percutaneous cholecystostomy group (P= 0.12). The 30-day mortality rates were non-significantly higher in the EGBD group (5 [8.5 %] vs. 1 [1.7 %];P= 0.21).ConclusionsEGBD and percutaneous cholecystostomy were both effective means of achieving gallbladder drainage. EGBD may be a promising alternative to percutaneous cholecystostomy for treatment of acute cholecystitis in patients who are unfit for surgery, provided that experienced endosonographers are available.
authors.affiliation: Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China.
authors.forename: Anthony Yuen Bun
authors.initials: AYB
authors.lastname: Teoh
authors.affiliation: Department of Medicine, University Hospital Rio Hortega, Valladolid, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Serna
authors.affiliation: Department of Medicine, University Hospital Rio Hortega, Valladolid, Spain.
authors.forename: Irene
authors.initials: I
authors.lastname: Penas
authors.affiliation: Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China.
authors.forename: Charing Ching Ning
authors.initials: CCN
authors.lastname: Chong
authors.affiliation: Department of Medicine, University Hospital Rio Hortega, Valladolid, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Perez-Miranda
authors.affiliation: Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China.|Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, China.
authors.forename: Enders K W
authors.initials: EKW
authors.lastname: Ng
authors.affiliation: Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China.|Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, China.
authors.forename: James Yun Wong
authors.initials: JYW
authors.lastname: Lau
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002681:China; D002763:Cholecystectomy / Q000379:methods; D041881:Cholecystitis, Acute / Q000601:surgery*; D002767:Cholecystostomy / Q000009:adverse effects / Q000379:methods; D057186:Comparative Effectiveness Research; D004322:Drainage / Q000009:adverse effects / Q000379:methods; D019160:Endosonography / Q000379:methods*; D005260:Female; D005704:Gallbladder / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D025321:Surgery, Computer-Assisted / Q000009:adverse effects / Q000379:methods