Endoscopic Ultrasound-Guided Gallbladder Drainage versus Percutaneous Gallbladder Drainage for Acute Cholecystitis: A Systematic Review and Meta-Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Definitions
- I.
- Technical success: Technical success was defined as successful placement of a drainage catheter or stent placement into the gallbladder, using PT-GBD or EUS-GBD, respectively.
- II.
- Clinical success: Clinical success was defined as the resolution of clinical symptoms of acute cholecystitis (e.g., fever, abdominal pain, and leukocytosis) within 3 days after the procedure.
- III.
- Re-intervention: Reintervention was defined as a repeat procedure due to stent or catheter blockage; a procedure for repositioning or replacement; or a procedure to prevent bleeding or to drain fluid.
2.2. Patients, Intervention, Comparison, and Outcomes (PICO)
- Patients: Patients with acute cholecystitis who were not surgical candidates for cholecystectomy.
- Intervention: Drainage of gallbladder through either EUS-GBD (treatment group).
- Comparison: PT-GBD (control group) for the treatment of acute cholecystitis.
- Outcome: Technical success, clinical success, need for reintervention, and rate of adverse events.
2.3. Selection Criteria
2.4. Search Strategy and Data Extraction
2.5. Outcome Measures
2.6. Quality Assessment
2.7. Statistical Analysis
3. Results
3.1. Search Results and Study Characteristics
3.2. Population and Procedure Characteristics
3.3. Pooled Estimates of Primary Outcomes
- Pooled proportions and odds ratio of technical success:
- b.
- Pooled proportions and odds ratio of clinical success:
- c.
- Pooled proportions and odds ratio of adverse events:
- d.
- Pooled proportions and odds ratio for reintervention:
3.3.1. Secondary Outcomes
- Pooled proportions and odds ratio for readmission:
- b.
- Pooled proportions and odds ratio of mortality:
- c.
- The pooled mean difference in procedure time:
- d.
- The pooled mean difference in length of hospital stays:
- e.
- Pooled proportion of cholecystectomy after successful drainage
3.3.2. Validation of Meta-Analysis Results
- Sensitivity analysis:
- b.
- Heterogeneity:
- c.
- Publication bias:
- d.
- Quality assessment:
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Author | Country | Type of Study | Stent Type | Follow Up Duration in Days | Patients (n) | Technical Success (n) | Clinical Success (n) | Adverse Events (n) | Reintervention (n) | Readmission (n) | Mortality (n) | Procedure Time (min) | |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Anderloni 2017 [12] * | Italy | Retrospective | LAMS | EUS-GBD | NA | 10 | 10 | 10 | 1 | NA | NA | NA | NA |
PT-GBD | NA | 10 | 10 | 10 | 2 | NA | NA | NA | NA | ||||
Chaar 2019 [13] * | USA | Retrospective | LAMS | EUS-GBD | 122.3 | 10 | 10 | 10 | 2 | 1 | 2 | 0 | 0 |
PT-GBD | 151.6 | 30 | 30 | 26 | 13 | 6 | 8 | 5 | 0 | ||||
Cho 2017 [14] * | Korea | Retrospective | LAMS | EUS-GBD | NA | 74 | 74 | 73 | 5 | 7 | NA | NA | NA |
PT-GBD | NA | 107 | 106 | 103 | 21 | 23 | NA | NA | NA | ||||
Irani 2017 [5] | International | Retrospective | LAMS | EUS-GBD | 215 (1–621) | 45 | 44 | 43 | 8 | NA | NA | 1 | 22 |
PT-GBD | 265 (1–1638) | 45 | 45 | 41 | 14 | NA | NA | 3 | 28 | ||||
Jang 2017 [15] | Korea | RCT | NBD | EUS-GBD | NA | 30 | 29 | 29 | 2 | NA | NA | NA | 24 |
PT-GBD | NA | 29 | 28 | 27 | 1 | NA | NA | NA | 23 | ||||
Siddiqui 2019 [18] | USA | Retrospective | LAMS | EUS-GBD | 156 | 102 | 96 | 92 | 13 | NA | NA | NA | NA |
PT-GBD | 156 | 146 | 143 | 141 | 29 | NA | NA | NA | NA | ||||
Saumoy 2019 [16] | USA | Retrospective | LAMS | EUS-GBD | NA | 13 | 13 | 13 | 2 | 8 | 4 | NA | NA |
PT-GBD | NA | 21 | 21 | 21 | 3 | 15 | 2 | NA | NA | ||||
Shah 2020 [17] * | USA | Retrospective | LAMS | EUS-GBD | NA | 33 | NA | NA | 2 | 1 | NA | 1 | NA |
PT-GBD | NA | 79 | NA | NA | 43 | 79 | NA | 4 | NA | ||||
Teoh 2017 [7] | Japan | Retrospective | LAMS | EUS-GBD | NA | 59 | 57 | 53 | 19 | NA | 4 | 5 | NA |
PT-GBD | NA | 59 | 59 | 56 | 44 | NA | 42 | 1 | NA | ||||
Teoh 2019 [19] | International | RCT | LAMS | EUS-GBD | 365 | 39 | 38 | 36 | 5 | 1 | 10 | 3 | 22.7 |
PT-GBD | 365 | 40 | 40 | 37 | 19 | 12 | 14 | 4 | 27.4 | ||||
Tyberg 2018 [6] | International | Prospective cohort study | Multiple | EUS-GBD | NA | 42 | 40 | 40 | 7 | 4 | 6 | 0 | NA |
PT-GBD | NA | 113 | 112 | 97 | 21 | 28 | 27 | 4 | NA |
Complications | EUS-GBD | PT-GBD |
---|---|---|
Abdominal pain | 6 | 47 |
Drain/stent dislodgement | 3 | 28 |
Bleeding | 10 | 22 |
Bile leak | 4 | 11 |
Infection | 0 | 9 |
Stent obstruction | 6 | 9 |
Recurrent cholecystitis | 6 | 8 |
Pericholecystic collection | 2 | 3 |
Pneumonia | 4 | 3 |
Bowel perforation | 3 | 0 |
Pneumoperitoneum | 2 | 0 |
Drainage around the catheter | 0 | 2 |
Peritonitis | 1 | 0 |
Analysis | Number of Studies | Pooled Proportions (EUS vs. PT) | Pooled Estimates Odds Ratio or Mean Difference (95% CI) | I2 | p-Value |
---|---|---|---|---|---|
Primary outcomes | |||||
Technical success | 10 | 89.9% vs. 87.5% | 0.40 (0.17–0.94) | 0% | p = 0.04 |
Clinical success | 10 | 97% vs. 94.1% | 1.35 (0.65–2.79) | 0% | p = 0.42 |
Adverse events | 11 | 14.6% vs. 30% | 0.35 (0.21–0.61) | 54.29% | p = 0.00 |
Reinterventions | 5 | 15% vs. 67% | 0.18 (0.05–0.57) | 67.48% | p = 0.02 |
Secondary outcomes | |||||
Readmission rate | 5 | 16.4% vs. 35.5% | 0.34 (0.08–1.54) | 85.39% | p = 0.16 |
Mortality | 6 | 4% vs. 5.5% | 0.73 (0.30–1.80) | 0% | p = 0.50 |
Procedure time | 3 | NA | 0.42 (−6.14, 6.98) | 84.43% | p = 0.90 |
Recurrent cholecystitis | 3 | 4.3% vs. 8.2% | 0.75 (0.15–3.79) | 55.55% | p = 0.73 |
Length of hospital stay | 5 | 7.4 ± 5.12 days vs. 11.3 ± 4.7 days | −3.53 (−5.91, −1.15) | 99.05% | p = 0.00 |
Cholecystectomy | 3 | 22.6% vs. 27.3% | 0.32 (0.08–1.32) | 66.93% | p = 0.12 |
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Boregowda, U.; Chen, M.; Saligram, S. Endoscopic Ultrasound-Guided Gallbladder Drainage versus Percutaneous Gallbladder Drainage for Acute Cholecystitis: A Systematic Review and Meta-Analysis. Diagnostics 2023, 13, 657. https://doi.org/10.3390/diagnostics13040657
Boregowda U, Chen M, Saligram S. Endoscopic Ultrasound-Guided Gallbladder Drainage versus Percutaneous Gallbladder Drainage for Acute Cholecystitis: A Systematic Review and Meta-Analysis. Diagnostics. 2023; 13(4):657. https://doi.org/10.3390/diagnostics13040657
Chicago/Turabian StyleBoregowda, Umesha, Millie Chen, and Shreyas Saligram. 2023. "Endoscopic Ultrasound-Guided Gallbladder Drainage versus Percutaneous Gallbladder Drainage for Acute Cholecystitis: A Systematic Review and Meta-Analysis" Diagnostics 13, no. 4: 657. https://doi.org/10.3390/diagnostics13040657