Endoscopic gallbladder drainage for management of acute cholecystitis.

BACKGROUND

Nonoperative gallbladder drainage methods for acute cholecystitis include percutaneous transhepatic gallbladder drainage and percutaneous transhepatic gallbladder aspiration, endoscopic nasogallbladder drainage and gallbladder stenting via a transpapillary endoscopic approach, and EUS-guided nasogallbladder drainage and gallbladder stenting via a transmural endoscopic approach.

OBJECTIVE

A systematic review was performed to evaluate the current potential role of each gallbladder drainage technique for acute cholecystitis.

DESIGN

MEDLINE, EMBASE, and manual searches were performed to identify pertinent English-language articles.

RESULTS

The technical success rate, clinical success rate, and the frequency of adverse events in percutaneous transhepatic gallbladder aspiration (n = 122) and percutaneous transhepatic gallbladder drainage (n = 246) were 93% and 98%, 83% and 90%, and 0.8% and 3.7%, respectively. In contrast, the technical success rate, clinical success rate, and the frequency of adverse events in endoscopic nasogallbladder drainage (n = 194) and endoscopic gallbladder stenting (n = 127) were 81% and 96%, 75% and 88%, and 3.6% (n = 7) and 6.3% (n = 8), respectively. Although there have been 2 small case series of successful EUS-guided transmural nasogallbladder drainage (total n = 12), the procedure was technically and clinically successful in all of the patients with 2 adverse events. Only 1 case of successful EUS-guided gallbladder stent placement without any procedure-related adverse events has been reported.

LIMITATIONS: Retrospective studies, small number of patients, and lack of randomized, controlled trials.

CONCLUSIONS

Although prospective evaluation of the feasibility, safety, and efficacy of these various approaches will help identify the most suitable therapeutic modality for patients with acute cholecystitis, endoscopic gallbladder drainage may have a high potential as an alternative drainage method in acute cholecystitis.