EUS-guided gallbladder drainage versus percutaneous gallbladder drainage in high-risk patients with acute cholecystitis: a propensity score-matched analysis.
Rishi Pawa, Nicholas Koutlas, Alexa Cecil, Robert Dorrell, Gregory Russell, Swati Pawa
{"title":"EUS-guided gallbladder drainage versus percutaneous gallbladder drainage in high-risk patients with acute cholecystitis: a propensity score-matched analysis.","authors":"Rishi Pawa, Nicholas Koutlas, Alexa Cecil, Robert Dorrell, Gregory Russell, Swati Pawa","doi":"10.1177/17562848251375376","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using lumen apposing metal stent (LAMS) has emerged as a treatment option in patients with acute cholecystitis (AC) deemed unfit for surgery. Prior to this technique, percutaneous transhepatic gallbladder drainage (PT-GBD) was the only drainage modality available for these patients.</p><p><strong>Objectives: </strong>This study compares clinical outcomes of EUS-GBD versus PT-GBD in high-risk surgical patients with AC.</p><p><strong>Design: </strong>From July 2019 to October 2023, all consecutive patients with AC undergoing EUS-GBD (using LAMS) and PT-GBD at a single academic medical center were retrospectively reviewed and analyzed.</p><p><strong>Methods: </strong>A propensity score-matched analysis using age, sex, and Charlson Comorbidity Index was performed. This was used to obtain a 1:1 ratio of PT-GBD:EUS-GBD patients. Technical success was defined as successful placement of LAMS or percutaneous cholecystostomy tube in the gallbladder. Clinical success was defined as resolution of patients' symptoms and normalization of white cell count within 96 h post procedure without recurrence of AC. Outcomes were analyzed using Fisher's exact test and Student's <i>t</i> test.</p><p><strong>Results: </strong>Following propensity score matching, 57 EUS-GBD patients were matched with 57 PT-GBD patients. Technical success was seen in 96% (55/57) in the EUS-GBD group and 98% (56/57) in the PT-GBD group (<i>p</i> > 0.99). Clinical success was observed in 93% (52/56) in EUS-GBD group and 80% (45/56) in PT-GBD group (<i>p</i> = 0.093). PT-GBD patients underwent more procedures than the EUS-GBD group (median 3 vs 2, <i>p</i> < 0.0001) and had more complications (44% vs 16%, <i>p</i> = 0.0010). The median survival was 573 days for EUS-GBD and 452 days for PT-GBD (<i>p</i> = 0.77).</p><p><strong>Conclusion: </strong>EUS-GBD is superior to PT-GBD, requiring fewer gallbladder-related procedures and lower rates of adverse events. Given these benefits, it has emerged as the preferred non-surgical alternative in the management of patients with AC who are poor surgical candidates.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251375376"},"PeriodicalIF":3.4000,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12449632/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Therapeutic Advances in Gastroenterology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/17562848251375376","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using lumen apposing metal stent (LAMS) has emerged as a treatment option in patients with acute cholecystitis (AC) deemed unfit for surgery. Prior to this technique, percutaneous transhepatic gallbladder drainage (PT-GBD) was the only drainage modality available for these patients.
Objectives: This study compares clinical outcomes of EUS-GBD versus PT-GBD in high-risk surgical patients with AC.
Design: From July 2019 to October 2023, all consecutive patients with AC undergoing EUS-GBD (using LAMS) and PT-GBD at a single academic medical center were retrospectively reviewed and analyzed.
Methods: A propensity score-matched analysis using age, sex, and Charlson Comorbidity Index was performed. This was used to obtain a 1:1 ratio of PT-GBD:EUS-GBD patients. Technical success was defined as successful placement of LAMS or percutaneous cholecystostomy tube in the gallbladder. Clinical success was defined as resolution of patients' symptoms and normalization of white cell count within 96 h post procedure without recurrence of AC. Outcomes were analyzed using Fisher's exact test and Student's t test.
Results: Following propensity score matching, 57 EUS-GBD patients were matched with 57 PT-GBD patients. Technical success was seen in 96% (55/57) in the EUS-GBD group and 98% (56/57) in the PT-GBD group (p > 0.99). Clinical success was observed in 93% (52/56) in EUS-GBD group and 80% (45/56) in PT-GBD group (p = 0.093). PT-GBD patients underwent more procedures than the EUS-GBD group (median 3 vs 2, p < 0.0001) and had more complications (44% vs 16%, p = 0.0010). The median survival was 573 days for EUS-GBD and 452 days for PT-GBD (p = 0.77).
Conclusion: EUS-GBD is superior to PT-GBD, requiring fewer gallbladder-related procedures and lower rates of adverse events. Given these benefits, it has emerged as the preferred non-surgical alternative in the management of patients with AC who are poor surgical candidates.
期刊介绍：
Therapeutic Advances in Gastroenterology is an open access journal which delivers the highest quality peer-reviewed original research articles, reviews, and scholarly comment on pioneering efforts and innovative studies in the medical treatment of gastrointestinal and hepatic disorders. The journal has a strong clinical and pharmacological focus and is aimed at an international audience of clinicians and researchers in gastroenterology and related disciplines, providing an online forum for rapid dissemination of recent research and perspectives in this area.
The editors welcome original research articles across all areas of gastroenterology and hepatology.
The journal publishes original research articles and review articles primarily. Original research manuscripts may include laboratory, animal or human/clinical studies – all phases. Letters to the Editor and Case Reports will also be considered.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
