Endoscopic Ultrasound-Guided Transmural and Percutaneous Transhepatic Gallbladder Drainage are Comparable for Acute Cholecystitis.
Gastroenterology. 2012 Jan 11;
Authors: Jang JW, Lee SS, Song TJ, Hyun YS, Park DH, Seo DW, Lee SK, Kim MH, Yun SC
Abstract
BACKGROUND & AIMS: Endoscopic ultrasound (EUS)-guided transmural gallbladder drainage (EUS-GBD) is an alternative to percutaneous transhepatic gallbladder drainage (PTGBD) for patients with acute, high-risk, or advanced-stage cholecystitis who do not respond to initial medical treatment and cannot undergo emergency cholecystectomy. However, the technical feasibility, efficacy, and safety of EUS-GBD and PTGBD have not been compared. METHODS: Fifty-nine patients with acute cholecystitis, who did not respond to initial medical treatment and were unsuitable for an emergency cholecystectomy, were randomly chosen to undergo EUS-GBD (n=30) or PTGBD (n=29). The technical feasibility, efficacy, and safety of EUS-GBD and PTGBD were compared. RESULTS: EUS-GBD and PTGBD showed similar technical (97%, 29/30 vs 97%, 28/29; 95% 1-sided confidence interval [CI] lower limit, -7%; P=.001 for non-inferiority margin of 15%) and clinical (100%, 29/29 vs 96%, 27/28; 95% 1-sided CI lower limit, -2%; P=.0001 for non-inferiority margin of 15%) success rates, and similar rates of complications (7%, 2/30 vs 3%, 1/29; P=.492 in Fisher's exact test) and conversions to open cholecystectomy (9%, 2/23 vs 12%, 3/26; P=.999 in Fisher's exact test). The median post-procedure pain score was significantly lower after EUS-GBD than after PTGBD (1 vs 5; P<.001 in the Mann-Whitney U-test). CONCLUSIONS: EUS-GBD is comparable to PTGBD in terms of the technical feasibility and efficacy; there were no statistical differences in the safety. EUS-GBD is a good alternative for high-risk patients with acute cholecystitis who cannot undergo an emergency cholecystectomy.
PMID: 22245666 [PubMed - as supplied by publisher]