Efficacy and safety of EUS-guided cholecystolithotomy: A meta-analysis

Background

The recurrence rate and readmission rate of patients with gallbladder stones and cholecystitis are high. Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is a new method for the treatment of cholecystitis in patients with high surgical risk. The acute symptoms can be relieved by drainage of bile, and cholecystolithotomy or polyp resection can be performed through a stent or fistula.

Aims

This article introduced the technique of EUS-guided cholecystolithotomy and conducted a meta-analysis evaluating its feasibility and safety.

Methods

Four electronic databases including SinoMed, CNKI, Wanfang Data, and PubMed were researched from inception to June 2022. Two researchers independently carried out literature screening and the data relevant to success rate and safety of per-oral cholecystoscopy were extracted for further meta-analysis by R Programming Language.

Results

A total of 7 studies with 129 patients were included in the present analysis. The results showed that the technical success rate of endoscopic ultrasonography-guided cholecystolithotomy was 97% [95%CI (92%-99%)], the clinical success rate was 93% [95%CI (87%–96%)]. The total adverse event rates were 34% [95% CI (14%–63%)]. Subgroup analysis of four major individual adverse events was fever 11.91% [95% CI (2.05%–46.62%)], peritonitis 2.33% [95% CI (0.75%–6.96%)], bleeding 4.37% [95% CI (0.72%–22.34%)], and abdominal pain 0.91% [95% CI (0.02%–26.38%)]. The adverse events were mild and recovered after conservative treatment.

Conclusion

EUS-guided cholecystolithotomy is a safe and alternative treatment modality for patients with symptomatic cholecystolithiasis, with acceptable procedure related complications. However, due to the limited data, further well-designed studies are warranted prior to confident adoption of the novel method into clinical practice.