Endoscopic ultrasound-guided gallbladder drainage versus percutaneous cholecystostomy for high risk surgical patients with acute cholecystitis: A systematic review and meta-Analysis

Abstract

Background Recent evidence suggests that endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is an effective and safe alternative to percutaneous drainage (PT-GBD). We conducted a systematic review and meta-Analysis to compare these two procedures in high risk surgical patients with acute cholecystitis. Methods A comprehensive electronic literature search was conducted for all articles published up to October 2017 to identify comparative studies between EUS-GBD and PT-GBD. A meta-Analysis was performed on outcomes including technical success, clinical success, post-procedure adverse events, length of hospital stay, unplanned hospital readmission, need for reintervention, recurrent cholecystitis, and disease-or treatment-related mortality for these two procedures. Results Five comparative studies (206 patients in the EUS-GBD group vs. 289 patients in the PT-GBD group), were included in the final analysis. There were no statistically significant differences in technical success (odds ratio [OR] 0.43, 95S% confidence interval [CI] 0.12 to 1.58; P S=S0.21; I 2 S=S0S%) and clinical success (OR 1.07, 95S%CI 0.36 to 3.16; P S=S0.90; I 2 S=S44S%) between the two procedures. EUS-GBD had fewer adverse events than PT-GBD (OR 0.43, 95S%CI 0.18 to 1.00; P S=S0.05; I 2 S=S66S%). Moreover, patients undergoing EUS-GBD had shorter hospital stays, with pooled standard mean difference of-S2.53 (95S%CIS-S4.28 to-S0.78; P S=S0.005; I 2 S=S98S%), and required significantly fewer reinterventions (OR 0.16, 95S%CI 0.04 to 0.042; PS