Long-term outcomes of endoscopic ultrasound-guided gallbladder drainage versus in situ or ex situ percutaneous gallbladder drainage in real-world practice

Feasibility of endoscopic transpapillary gallbladder drainage for acute gangrenous cholecystitis in poor surgical candidates

OBJECTIVES

Surgery is generally the first choice of treatment for gangrenous cholecystitis (GC). However, some patients are not fit for surgery because of their comorbidities. We evaluated the feasibility of endoscopic transpapillary gallbladder drainage (ETGBD) for GC in poor surgical candidates.

METHODS

This retrospective study compared the outcomes of ETGBD for acute cholecystitis (AC) with and without complicated GC. Of the 136 patients who underwent ETGBD for AC at a single tertiary referral center between January 2019 and July 2023, 91 who underwent contrast-enhanced computed tomography (CT) before ETGBD were included in the analysis.

RESULTS

Patients were assigned to the GC (n = 29) and non-GC (n = 62) groups based on CT findings. The technical success rate of ETGBD, clinical success rate for AC, and rate of early adverse events (AEs) in the GC and non-GC groups were 86.2% vs. 91.9% (P = 0.63), 79.3% vs. 91.9% (P = 0.17), and 27.6% vs. 16.1% (P = 0.32), respectively. The technical and clinical success rates were slightly lower, while the early AE rate was higher in the GC group. However, the differences were not significant. The incidence of late AEs was 15.8% in the GC group and 17.9% in the non-GC group, with no significant difference (P = 0.87). Elective cholecystectomy was significantly less frequent in the GC group (P = 0.023).

CONCLUSION

ETGBD is a feasible treatment option for GC in patients contraindicated for surgery.

A review of endoscopic ultrasound-guided gallbladder drainage and gastroenterostomy: assisted approaches and comparison with alternative techniques

Over the last 40 years, the role of endoscopic ultrasound (EUS) has evolved from being diagnostic to therapeutic. EUS-guided gallbladder drainage (EUS-GBD) and EUS-guided gastroenterostomy (EUS-GE) are emerging techniques in recent years; however, there are limited studies and inconsistent results regarding these techniques. In addition, EUS has become a more common alternative to traditional interventions due to its super minimally invasive nature, but the mobility of both the gallbladder and intestine makes it challenging to introduce stents. An increasing number of researchers are dedicating themselves to solving this problem, leading to the development of various assisted technologies. Consequently, this review focused on the comparison of EUS-GBD and EUS-GE with other alternative approaches and explored the various assisted techniques employed for EUS-GBD and EUS-GE.

Endoscopic internalization by cutting versus removal of the endoscopic transpapillary naso-gallbladder drainage tube in preoperative management of acute cholecystitis: A retrospective multicenter cohort study

BACKGROUND

Endoscopic transpapillary naso-gallbladder drainage (ENGBD) has been reported to be an effective treatment option for acute cholecystitis. At our institution, ENGBD was first placed for external fistula management, and endoscopic internalization by cutting was performed, shifting to endoscopic transpapillary gallbladder stenting (EGBS) after improvement of cholecystitis. However, there has been no comparative study to define which preoperative management is better: converting ENGBD to EGBS or removing ENGBD. The study aimed to compare the incidence rate of the late adverse events (AEs) related to biliary system between shifting from ENGBD to EGBS and removal of ENGBD.

METHODS

We retrospectively studied 122 patients who underwent ENGBD for acute cholecystitis between January 2010 and October 2022. The patients were divided into two groups: the cutting group (converting ENGBD to EGBS) and the removal group (removal of ENGBD). The short and late clinical outcomes were compared between groups.

RESULTS

Endoscopic transpapillary naso-gallbladder drainage was successfully placed in 78.6% (96/122), and elective cholecystectomy was performed in 31 and 36 patients in the cutting and removal groups, respectively. The cumulative late-AE rates were 6.4% and 33.3% (p = .007), with a median waiting period for elective cholecystectomy of 58 and 33 days (p = .390) in the cutting and removal groups, respectively. In the multivariate analysis, only endoscopic internalization by cutting was an independent factor affecting late AEs.

CONCLUSION

Endoscopic internalization by cutting ENGBD after the resolution of acute cholecystitis was considered effective in reducing the risk of late AEs during the waiting period for an elective cholecystectomy.