Post written by Suchapa Arayakarnkul, MD, and Rahul Karna, MD, from the University of Minnesota, Minneapolis, Minnesota, and Mohammad Bilal, MD, from the University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA.

In this systematic review and meta-analysis, we assessed the outcomes of interval cholecystectomy (CCY) after EUS-guided gallbladder drainage (EUS-GBD), with a focus on technical successes, surgical techniques, and procedural safety measured in terms of adverse events.

Interval CCY after EUS-GBD is an interesting topic. This is because, traditionally, EUS-GBD has typically been considered a definitive therapy in patients who are not surgical candidates. However, many of these patients may recover from acute illness and become optimal surgical candidates later.

Recently, EUS-GBD has become a popular option for endoscopic management of acute cholecystitis in patients who are high-risk surgical candidates. The U.S. Food and Drug Administration also approved the use of lumen-apposing metal stents for management of acute cholecystitis. CCY can be beneficial in these patients when they become optimal surgical candidates to prevent recurrent pancreatobiliary events.

To our knowledge, there have been few reports on the outcomes of this group of patients–with the focus especially on the increased surgical complexity from the cholecystoenteric fistula formed at the stent site. Therefore, we decided to perform a systematic review and meta-analysis to investigate the feasibility of interval CCY and outcomes in this group of patients.

Our study demonstrates that interval CCY is feasible after EUS-GBD in a select group of patients. Pooled proportion of successful interval CCY was 32.9%, with the majority undergoing laparoscopic CCY (76.2%), followed by open CCY in 14.5% and conversion from laparoscopic to open CCY in 14%. The pooled proportion of overall adverse events was 13.2%, and there was no procedure-related mortality.

Although our study shows promise, endoscopists should still consider local surgical expertise before performing EUS-GBD in patients who will eventually become surgical candidates. Future studies should focus on assessment of adhesions, technical complexity, operative time, blood loss, and safety analysis in a larger cohort of patients. It also would be interesting to see the outcomes of patients who do not undergo interval CCY after EUS-GBD and evaluate long-term follow-up outcomes in these patients.

Graphical abstract

Read the full article online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.