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Three-way comparative study of endoscopic ultrasound-guided transmural gallbladder drainage using lumen-apposing metal stents versus endoscopic transpapillary drainage versus percutaneous cholecystostomy for gallbladder drainage in high-risk surgical patients with acute cholecystitis: clinical outcomes and success in an International, Multicenter Study

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Abstract

Background

Percutaneous cholecystostomy tube (PTGBD), endoscopic retrograde cholangiopancreatography with transpapillary gallbladder drainage (TP), and endoscopic ultrasound-guided transmural gallbladder drainage (EGBD) using lumen-apposing metal stents (LAMS) have been offered for gallbladder decompression for acute cholecystitis in high-risk surgical patients. Yet, there are limited data comparing these therapies. Our aim was to compare the safety and efficacy of EGBD to TP and PTGBD for gallbladder drainage.

Methods

We retrospectively collected high-risk surgical patients from six centers with acute cholecystitis who underwent gallbladder drainage by EGBD, TP, or PTGBD. Data included technical success (gallbladder drainage), clinical success (acute cholecystitis resolution), adverse events (AE), and follow-up.

Results

From 2010 to 2016, 372 patients underwent gallbladder drainage, with 146 by PTGBD, 124 by TP, and 102 drained by EGBD. Technical (98% vs. 88% vs. 94%; p = 0.004) and Clinical (97% vs. 90% vs. 80%; p < 0.001) success rates were significantly higher with PTGBD and EGBD compared to TP. PTGBD group had statistically significantly higher number of complications as compared to EGBD and TP groups (2 0% vs. 2% vs. 5%; p = 0.01). Mean hospital stay in the EGBD group was significantly less than TP and PTGBD (16 vs. 18 vs. 19 days; p = 0.01), while additional surgical intervention was significantly higher in the PTGBD group compared to the EGBD and TP groups (49% vs. 4% vs. 11%; p < 0.0001).

Conclusions

EGBD with LAMS is an effective and safer alternative to TP and PTGBD for treatment of patients with acute cholecystitis who cannot undergo surgery. EGBD with LAMS has significantly lower overall AEs, hospital stay, and unplanned admissions compared to PTGBD. Trial registration: ClinicalTrials.gov Identifier: NCT01522573.

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Author notes

  1. Ali Siddiqui and Rastislav Kunda are first authors.

Authors and Affiliations

  1. Thomas Jefferson University, Philadelphia, PA, USA

    Ali Siddiqui, Arish Noor, Tayebah Mumtaz, Usama Iqbal, David E. Loren & Thomas E. Kowalski

  2. Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA

    Amy Tyberg, Monica Saumoy, Monica Gaidhane & Michel Kahaleh

  3. Aarhus University, Aarhus, Denmark

    Rastislav Kunda

  4. University of Minnesota, Minneapolis, MN, USA

    Mustafa A. Arain, Shawn Mallery & Eric M. Christiansen

  5. University of Utah, Salt Lake City, UT, USA

    Douglas G. Adler

  6. Borland-Groover Clinic, Jacksonville, FL, USA

    Jose Nieto

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  1. Ali Siddiqui
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Corresponding author

Correspondence to Michel Kahaleh.

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Disclosures

Michel Kahaleh, MD has received grant support from Boston Scientific, Fujinon, EMcision, Xlumena Inc., W.L. Gore, MaunaKea, Apollo Endosurgery, Cook Endoscopy, ASPIRE Bariatrics, GI Dynamics, NinePoint Medical, Merit Medical, Olympus, and MI Tech. He is a consultant for Boston Scientific, Xlumena Inc., Concordia Laboratories Inc, AbbVie, and MaunaKea Tech. Ali Siddiqui, MD is a consultant for Boston Scientific, Cook Endoscopy, and Medtronic. He has received research grant support from Boston Scientific and Medtronic. He is a speaker for AbbVie. Jose Nieto, MD is a consultant for Boston Scientific. Shawn Mallery, MD is a consultant for Boston Scientific. Douglas Adler, MD is a consultant for Boston Scientific. Thomas Kowalski, MD is a consultant for Boston Scientific and Medtronic. David Loren, MD is a consultant for Boston Scientific and has received grant support from Medtronic. Rastislav Kunda, MD is a consultant for Boston Scientific, BCM Korea, Olympus Japan, and Omega Medical Imaging. Eric Chrisiansen MD, Monica Gaidhane MD, Amy Tyberg MD, Usama Iqbal MD, Tayebah Mumtaz MD, Arish Noor MD, Mustafa Arain MD, and Monica Saumoy MD, have no conflicts of interest or financial ties to disclose.

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Siddiqui, A., Kunda, R., Tyberg, A. et al. Three-way comparative study of endoscopic ultrasound-guided transmural gallbladder drainage using lumen-apposing metal stents versus endoscopic transpapillary drainage versus percutaneous cholecystostomy for gallbladder drainage in high-risk surgical patients with acute cholecystitis: clinical outcomes and success in an International, Multicenter Study. Surg Endosc 33, 1260–1270 (2019). https://doi.org/10.1007/s00464-018-6406-7

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  • DOI: https://doi.org/10.1007/s00464-018-6406-7

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