Time to face the facts: EUS gallbladder drainage is here to stay

EUS-guided gallbladder drainage (EUS-GBD) has been increasingly recognized as an effective treatment option for patients with acute cholecystitis who cannot undergo surgical cholecystectomy, alongside the historically traditional therapeutic options of percutaneous transhepatic (PT-GBD) and endoscopic retrograde cholangiopancreatography transpapillary (ETP-GBD).1Lee S.S. Park D.H. Hwang C.Y. et al.EUS-guided transmural cholecystostomy rescue management in elderly or high-risk patients: a prospective feasibility study.Gastrointest Endosc. 2007; 66: 1008-1012Abstract Full Text PDF PubMed Scopus (91) Google Scholar,2Tyberg A. Saumoy M. Sequeiros E.V. versus drainage: Isn’t it time to convert?.J Clin Gastroenterol. 2018; 52: 79-84Crossref (65) Scholar All 3 procedures have shown be both efficacious safe nonsurgical patients. However, there is currently paucity research that directly compares all procedures. A systematic review meta-analysis by Podboy al3Podboy Yuan J. Stave C.D. al.Comparison cholecystitis: network meta-analysis.Gastrointest 2021; 93: 797-804.e1Abstract (14) methods identify optimal modality The analysis included 10 studies comprising 2 randomized controlled trials 8 retrospective total 1267 whom 472 underwent EUS-GBD, 493 PT-GBD, 302 ETP-GBD. found highest technical clinical success rates were obtained EUS-GBD PT-GBD compared overall adverse event ETP-GBD group, although similar across groups. Recurrent was lowest group need reintervention rate unplanned admission group. Mortality Previous outcomes this analysis. recent 82 96.7% EUS-GTB 88.1% 89.3% PT-GBD.4Mohan B.P. Khan S.R. Trakroo S. al.Endoscopic ultrasound-guided drainage, high risk comparative meta-analysis.Endoscopy. 2020; 96-106Crossref (42) In retrospective, international, multicenter analysis, significantly lower events, decreased length hospital stay, fewer admissions.5Siddiqui Kunda R. Tyberg al.Three-way study using lumen-apposing metal stents study.Surg 2019; 33: 1260-1270Crossref (51) had statistically higher number events than groups (20% vs 2% 5%; P = .01), additional intervention (49% 4% 11%; < .0001). This also associated postprocedure shorter stays, reinterventions, readmissions PT-GBD. Most recently, control 80 comparing efficacy, but immediate long-term (1 year) rate, admissions, recurrent cholecystitis.6Teoh A.Y.B. Kitano Itoi T. al.Endosonography-guided very international randomised multicentre superiority trial (DRAC 1).Gut. 69: 1085-1091Crossref (59) So how know which procedure patient? technically easiest perform near equivalent EUS-GBD; however, worst terms admissions EUS-GBD. markedly favored readmission/reintervention, making choice quality life. seems safest mortality reintervention/unplanned least well slightly events. require patient able tolerate anesthesia, unlike And may not feasible coagulopathies large ascites. Given varied advantages disadvantages each intervention, must based on scenario factors. For will ultimately preferred over due admissions. likely only justified if needs concurrent ERCP biliary decompression because (presumably ERCP-associated) technical/clinical rates. sacrifices just cholecystitis, less issue planned imminent surgery drawback delayed surgery. before cholecystectomy widely accepted studied, small show no difference approach (open laparoscopic) when presurgical performed PT-GBD.7Saumoy Brown E. al.Successful after ultrasound cholecystostomy, can done?.J 53: 231-235Crossref (20) What undeniable, confirmed line previous studies, should definitive future reintervention, are significant population. With introduction stents, become safer, negating migration bile leaks seen use plastic tubular stents. addition, offers other unmeasured benefits, such positive impact life avoiding drain ability traverse stent endoscope remove troublesome gallstones even evaluate dysplastic tissue. operator experience important As authors point out, done at tertiary centers expertise EUS generalizable. showed learning 19 cases reach efficiency already expert EUS.8Tyberg Jha K. Shah curve modified progress.Endosc Int Open. 8: E92-E96Crossref conclusion, dependent scenario, patient-specific factors, available expertise. efficacy paired reinterventions/readmissions made favorite patients, leaving without access interventions unable safely coagulopathy It remains determined enough echoendoscopists take cholecystitic gallbladders. Dr consultant EndoGastric Solutions, Boston Scientific, Steris Endoscopy. Comparison meta-analysisGastrointestinal EndoscopyVol. 93Issue 4PreviewThe method (GBD) candidates uncertain. aim current conduct GBD (percutaneous [PT], [ETP], EUS-guided). Full-Text