Endoscopic ultrasound-guided gallbladder drainage versus percutaneous cholecystostomy for high risk surgical patients with acute cholecystitis: a systematic review and meta-analysis
Publication in refereed journal

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摘要Background Recent evidence suggests that endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is an effective and safe alternative to percutaneous drainage (PT-GBD). We conducted a systematic review and meta-analysis to compare these two procedures in high risk surgical patients with acute cholecystitis.

Methods A comprehensive electronic literature search was conducted for all articles published up to October 2017 to identify comparative studies between EUS-GBD and PT-GBD. A meta-analysis was performed on outcomes including technical success, clinical success, post-procedure adverse events, length of hospital stay, unplanned hospital readmission, need for reintervention, recurrent cholecystitis, and disease- or treatment-related mortality for these two procedures.

Results Five comparative studies (206 patients in the EUS-GBD group vs. 289 patients in the PT-GBD group), were included in the final analysis. There were no statistically significant differences in technical success (odds ratio [OR] 0.43, 95% confidence interval [CI] 0.12 to 1.58; P =0.21; I-2 =0%) and clinical success (OR 1.07, 95%CI 0.36 to 3.16; P =0.90; I-2 =44%) between the two procedures. EUS-GBD had fewer adverse events than PT-GBD (OR 0.43, 95%CI 0.18 to 1.00; P =0.05; I-2 =66%). Moreover, patients undergoing EUS-GBD had shorter hospital stays, with pooled standard mean difference of -2.53 (95%CI-4.28 to -0.78; P =0.005; I-2 =98%), and required significantly fewer reinterventions (OR 0.16, 95%CI 0.04 to 0.042; P< 0.001; I-2 =32%) resulting in significantly fewer unplanned readmissions (OR 0.16, 95%CI 0.05 to 0.53; P =0.003; I-2 =79%).

Conclusions EUS-GBD was associated with lower rates of post-procedure adverse events, shorter hospital stays, and fewer reinterventions and readmissions compared with PT-GBD in patients with acute cholecystitis who were unfit for surgery.
出版社接受日期23.04.2019
著者Luk SWY, Irani S, Krishnamoorthi R, Lau JYW, Ng EKW, Teoh AYB
期刊名稱Endoscopy
出版年份2019
月份8
卷號51
期次8
出版社Thieme Publishing
頁次722 - 732
國際標準期刊號0013-726X
語言英式英語
Web of Science 學科類別Gastroenterology & Hepatology;Surgery;Gastroenterology & Hepatology;Surgery

上次更新時間 2020-06-08 於 23:53