Comparison of Three Gallbladder Drainage Methods for Acute Cholecystitis: A Systematic Review With Network Meta-Analysis.

BACKGROUND

The effectiveness of endoscopic transpapillary gallbladder drainage (ETGBD), percutaneous gallbladder drainage (PTGBD), and endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) for treating acute cholecystitis in individuals with elevated surgical risk is not yet thoroughly evaluated.

METHODS

The clinical success, technical success, and rates of adverse events for these three therapies were assessed using a random-effects model in a network meta-analysis of 2254 patients from 17 trials. We computed risk ratios (RR), 95% confidence intervals (CI), and standard mean differences (SMD), and treatments were ranked using P-scores.

RESULTS

PTGBD and EUS-GBD demonstrated superior technical success rates compared to ETGBD (ETGBD vs. EUS-GBD: 95% CI: 0.80-0.88, RR = 0.85; ETGBD vs. PTGBD: 95% CI: 0.79-0.86, RR = 0.83). Similarly, PTGBD and EUS-GBD achieved greater rates of clinical success than ETGBD (ETGBD vs. EUS-GBD: 95% CI: 0.75-0.86, RR = 0.81; ETGBD vs. PTGBD: 95% CI: 0.78-0.90, RR = 0.83). Procedure-related adverse effects did not differ among these three modalities. Based on ranking estimates, although EUS-GBD had the smallest likelihood of adverse events and was predicted to provide maximum clinical success, the highest technical success was probably anticipated from PTGBD.

CONCLUSION

Endoscopic gallbladder drainage (EUS-GBD or ETGBD) is a preferred first-line option in centers with advanced endoscopic expertise. PTGBD remains a valuable alternative when such expertise is not available.