Operative outcomes of interval cholecystectomy after gallbladder drainage for acute cholecystitis: a systematic review and meta-analysis comparing endoscopic and percutaneous approaches.

BACKGROUND

Acute cholecystitis in high-risk surgical candidates is frequently managed with gallbladder drainage as a bridge to interval cholecystectomy. Each drainage modality-percutaneous transhepatic (PTGBD), EUS-guided (EUS-GBD), and endoscopic transpapillary (ETGBD)-has distinct anatomical effects that may influence subsequent cholecystectomy. While multiple meta-analyses have established drainage efficacy, comparative evidence regarding operative outcomes of interval surgery remains limited.

METHODS

We performed a systematic review and meta-analysis following PRISMA 2020 (PROSPERO: CRD420251232718). Five databases were searched (January 2000-December 2025) for comparative studies reporting operative outcomes of interval cholecystectomy after gallbladder drainage. Primary outcomes were conversion to open cholecystectomy and subtotal cholecystectomy. Random-effects models with Hartung-Knapp adjusted confidence intervals were used. Certainty of evidence was assessed using the GRADE approach.

RESULTS

Ten comparative studies (2019-2025) were included. Meta-analysis of EUS-GBD versus PTGBD (3 studies, n = 215) showed no statistically significant difference in conversion to open cholecystectomy (6.4% vs. 16.5%; RR 0.51, 95% CI 0.23-1.13; P = 0.07; I²=0%). Meta-analysis of EGBS versus PTGBD (6 studies, n = 416) found no statistically significant difference in conversion (18.9% vs. 17.6%; RR 1.14, 95% CI 0.25-5.23; P = 0.83; I²=77%) or subtotal cholecystectomy (RR 1.16, 95% CI 0.61-2.18; P = 0.52; I²=0%). One RCT comparing ENGBD versus PTGBD (n = 22) was synthesized descriptively. Certainty of evidence was low to very low.

CONCLUSIONS

No statistically significant differences in operative outcomes of interval cholecystectomy were found between endoscopic and percutaneous gallbladder drainage modalities (low to very low certainty of evidence). Given comparable operative outcomes, drainage modality selection may be guided by drainage efficacy, patient anatomy, and institutional expertise.

PROSPERO REGISTRATION: CRD420251232718.