Nikhil A. Kumta, MD, from the Division of Gastroenterology and Hepatology, Weill Cornell Medical College, in New York, New York, USA discusses this Original Article, “Endoscopic gallbladder drainage compared with percutaneous drainage.”
Our aim was to compare endoscopic gallbladder drainage (EGBD) and percutaneous gallbladder drainage (PGBD) for patients with cholecystitis who were non-surgical candidates in terms of technical and clinical success, length of hospital stay, time to clinical resolution, adverse events, number of sessions, number of repeat interventions, and post-procedure pain scores. An increasing number of patients with comorbidities who are poor surgical candidates will require management of cholecystitis.
The conventional treatment for this patient cohort has been PGBD via cholecystostomy tube placement. Although the technical success rate of this technique is high, approximately 97% to 98%, it carries up to 14% risk of adverse events including pneumothorax, bile leak, subcapsular hematoma, pain, and catheter misplaced/migration. More recently, 2 types of endoscopic methods of gallbladder drainage have been described: transpapillary drainage via cystic duct stent placed during ERCP, and EUS-guided transmural drainage with transgastric or transduodenal stent placement. Our retrospective study identified 73 non-surgical patients with cholecystitis. Among them, 30 patients (41.1%) underwent endoscopic drainage (24 transpapillary, 6 transmural) and 43 patients (58.9%) had PGBD. There were no significant differences between the groups with regard to demographics, concomitant choledocholithiasis, and baseline severity index. There was no difference in technical success or clinical success between EGBD and PGBD. The mean time to clinical resolution was significantly higher in the percutaneous group, at 4.6 days, versus the endoscopic group, at 2.95 days, P = .05. The mean number of sessions for the PGBD and EGBD was 2.0 versus 1.06, P < .0001. The mean post-procedure pain score was 2.1 for the endoscopic group and 3.8 for the percutaneous group, P = .028. The re-intervention rate was significantly higher in the PGBD group compared with the EGBD group (53% vs 13%; P = .004).
Although EGBD has similar technical and clinical success compared with PGBD, it uses fewer hospital resources and results in fewer adverse events, improved pain scores, and decreased need for repeat gallbladder drainage. The clinical implication of this study is that for patients with cholecystitis that are non-surgical candidates, EGBD may provide a less-invasive, safer, cost-effective option for gallbladder drainage than PGBD with improved clinical outcomes.
Find the abstract for this article here.
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