Endoscopic ultrasound (EUS)-guided cholecystostomy versus percutaneous cholecystostomy (PTC) in the management of acute cholecystitis in patients unfit for surgery: a systematic review and meta-analysis.

Autor: Hemerly MC; Departamento de Gastroenterologia, Faculdade de Medicina, Serviço de Endoscopia Gastrointestinal Do Hospital das Clínicas HCFMUSP, Universidade de Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255 - Instituto Central - Prédio Dos Ambulatórios, Cerqueira César, Sao Paulo, SP, CEP: 05403-000, Brazil., de Moura DTH; Departamento de Gastroenterologia, Faculdade de Medicina, Serviço de Endoscopia Gastrointestinal Do Hospital das Clínicas HCFMUSP, Universidade de Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255 - Instituto Central - Prédio Dos Ambulatórios, Cerqueira César, Sao Paulo, SP, CEP: 05403-000, Brazil., do Monte Junior ES; Departamento de Gastroenterologia, Faculdade de Medicina, Serviço de Endoscopia Gastrointestinal Do Hospital das Clínicas HCFMUSP, Universidade de Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255 - Instituto Central - Prédio Dos Ambulatórios, Cerqueira César, Sao Paulo, SP, CEP: 05403-000, Brazil., Proença IM; Departamento de Gastroenterologia, Faculdade de Medicina, Serviço de Endoscopia Gastrointestinal Do Hospital das Clínicas HCFMUSP, Universidade de Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255 - Instituto Central - Prédio Dos Ambulatórios, Cerqueira César, Sao Paulo, SP, CEP: 05403-000, Brazil., Ribeiro IB; Departamento de Gastroenterologia, Faculdade de Medicina, Serviço de Endoscopia Gastrointestinal Do Hospital das Clínicas HCFMUSP, Universidade de Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255 - Instituto Central - Prédio Dos Ambulatórios, Cerqueira César, Sao Paulo, SP, CEP: 05403-000, Brazil. igorbraga1@gmail.com., Yvamoto EY; Departamento de Gastroenterologia, Faculdade de Medicina, Serviço de Endoscopia Gastrointestinal Do Hospital das Clínicas HCFMUSP, Universidade de Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255 - Instituto Central - Prédio Dos Ambulatórios, Cerqueira César, Sao Paulo, SP, CEP: 05403-000, Brazil., Ribas PHBV; Departamento de Gastroenterologia, Faculdade de Medicina, Serviço de Endoscopia Gastrointestinal Do Hospital das Clínicas HCFMUSP, Universidade de Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255 - Instituto Central - Prédio Dos Ambulatórios, Cerqueira César, Sao Paulo, SP, CEP: 05403-000, Brazil., Sánchez-Luna SA; Department of Internal Medicine, Division of Gastroenterology & Hepatology, Basil I. Hirschowitz Endoscopic Center of Excellence, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA., Bernardo WM; Departamento de Gastroenterologia, Faculdade de Medicina, Serviço de Endoscopia Gastrointestinal Do Hospital das Clínicas HCFMUSP, Universidade de Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255 - Instituto Central - Prédio Dos Ambulatórios, Cerqueira César, Sao Paulo, SP, CEP: 05403-000, Brazil., de Moura EGH; Departamento de Gastroenterologia, Faculdade de Medicina, Serviço de Endoscopia Gastrointestinal Do Hospital das Clínicas HCFMUSP, Universidade de Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255 - Instituto Central - Prédio Dos Ambulatórios, Cerqueira César, Sao Paulo, SP, CEP: 05403-000, Brazil.
Jazyk: angličtina
Zdroj: Surgical endoscopy [Surg Endosc] 2023 Apr; Vol. 37 (4), pp. 2421-2438. Date of Electronic Publication: 2022 Oct 26.
DOI: 10.1007/s00464-022-09712-x
Abstrakt: Background and Aim: Surgical cholecystectomy is the gold standard strategy for the management of acute cholecystitis (AC). However, some patients are considered unfit for surgery due to certain comorbid conditions. As such, we aimed to compare less invasive treatment strategies such as endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) and percutaneous gallbladder drainage (PT-GBD) for the management of patients with AC who are suboptimal candidates for surgical cholecystectomy.
Methods: A comprehensive search of multiple electronic databases was performed to identify all the studies comparing EUS-GBD versus PT-GBD for patients with AC who were unfit for surgery. A subgroup analysis was also performed for comparison of the group undergoing drainage via cautery-enhanced lumen-apposing metal stents (LAMS) versus PT-GBD. The outcomes included technical and clinical success, adverse events (AEs), recurrent cholecystitis, reintervention, and hospital readmission.
Results: Eleven studies including 1155 patients were included in the statistical analysis. There was no difference between PT-GBD and EUS-GBD in all the evaluated outcomes. On the subgroup analysis, the endoscopic approach with cautery-enhanced LAMS was associated with lower rates of adverse events (RD =  - 0.33 (95% CI - 0.52 to - 0.14; p = 0.0006), recurrent cholecystitis (- 0.05 RD (95% CI - 0.09 to - 0.02; p = 0.02), and hospital readmission (- 0.36 RD (95% CI-0.70 to - 0.03; p = 0.03) when compared to PT-GBD. All other outcomes were similar in the subgroup analyses.
Conclusions: EUS-GBD using cautery-enhanced LAMS is superior to PT-GBD in terms of safety profile, recurrent cholecystitis, and hospital readmission rates in the management of patients with acute cholecystitis who are suboptimal candidates for cholecystectomy. However, when cautery-enhanced LAMS are not used, the outcomes of EUS-GBD and PT-GBD are similar. Thus, EUS-GBD with cautery-enhanced LAMS should be considered the preferable approach for gallbladder drainage for this challenging population.
(© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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