title: EUS-guided Versus Percutaneous Gallbladder Drainage: Isn't It Time to Convert?
abstract: OBJECTIVE
  Endoscopic ultrasound-guided drainage (EUS-GLB) is a minimally invasive option for patients with cholecystitis who are poor surgical candidates. Compared with percutaneous drainage (PC-GLB), earlier studies have demonstrated similar efficacy with improved quality of life. We present a multicenter, international experience comparing PC-GLB and EUS-GLB in nonsurgical patients with cholecystitis.
  
  
  METHODS
  All patients who underwent either PC-GLB drainage or EUS-GLB drainage from 7 centers between January 2010 and December 2015 were included. Technical success was defined as successful placement of a catheter or stent into the gallbladder. Clinical success was defined as resolution of clinical symptoms after intervention. Adverse events, length of stay, and the need for repeat interventions and/or hospitalizations were recorded for all patients.
  
  
  RESULTS
  A total of 155 patients were included (mean age 74±14.24 y; range, 31 to 96; 56% male). Forty-two patients underwent EUS-GLB and 113 patients underwent PC-GLB. Technical success was achieved in 40 patients (95%) in the EUS-GLB group and 112 patients (99%) in the PC-GLB group (P=0.179). Clinical success was achieved in 40 patients (95%) in the EUS-GLB group and 97 patients (86%) in the PC-GLB group (P=0.157). There was no difference in hospital readmission rates between the 2 groups (14% vs. 24%; P=0.194). However, there was significantly higher number of patients requiring repeat interventions in the PC-GLB group (n=28, 24%) compared with the EUS-GLB group (n=4, 10%) (P=0.037). There was no difference in adverse events between the 2 groups.
  
  
  CONCLUSIONS
  EUS-GLB is safe and efficacious, with comparable technical and clinical success rates and no difference in adverse events. In addition, EUS-GLB offers a potential cost-saving benefit and morbidity benefit by demonstrating a decreased number of repeat interventions.
authors.affiliation: Division of Gastroenterology & Hepatology, Weill Cornell Medical College, New York, NY.
authors.forename: Amy
authors.initials: A
authors.lastname: Tyberg
authors.affiliation: Division of Gastroenterology & Hepatology, Weill Cornell Medical College, New York, NY.
authors.forename: Monica
authors.initials: M
authors.lastname: Saumoy
authors.affiliation: Endoscopy Unit, Gastroenterology Division, University Hospital Ramón y Cajal, IRYCIS.|Gastroenterology Division, University Hospital Quirón, Madrid, Spain.
authors.forename: Enrique V
authors.initials: EV
authors.lastname: Sequeiros
authors.affiliation: Department of Gastroenterology and Endoscopy, Paoli-Calmettes Institute, Marseille, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Giovannini
authors.affiliation: GI Endoscopy Unit, Department of Surgery, Ana Costa Hospital, Santos, Brazil.
authors.forename: Everson
authors.initials: E
authors.lastname: Artifon
authors.affiliation: Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Anthony
authors.initials: A
authors.lastname: Teoh
authors.affiliation: Borland-Groover Clinic, Jacksonville, FL.
authors.forename: Jose
authors.initials: J
authors.lastname: Nieto
authors.affiliation: Division of Gastroenterology & Hepatology, Weill Cornell Medical College, New York, NY.
authors.forename: Amit P
authors.initials: AP
authors.lastname: Desai
authors.affiliation: Division of Gastroenterology & Hepatology, Weill Cornell Medical College, New York, NY.
authors.forename: Nikhil A
authors.initials: NA
authors.lastname: Kumta
authors.affiliation: Division of Gastroenterology & Hepatology, Weill Cornell Medical College, New York, NY.
authors.forename: Monica
authors.initials: M
authors.lastname: Gaidhane
authors.affiliation: Division of Gastroenterology & Hepatology, Weill Cornell Medical College, New York, NY.
authors.forename: Reem Z
authors.initials: RZ
authors.lastname: Sharaiha
authors.affiliation: Division of Gastroenterology & Hepatology, Weill Cornell Medical College, New York, NY.
authors.forename: Michel
authors.initials: M
authors.lastname: Kahaleh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D041881:Cholecystitis, Acute / Q000601:surgery*; D004322:Drainage / Q000379:methods*; D019160:Endosonography; D005260:Female; D014943:Global Health; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional