Su1281 COMPARISON OF EUS-GUIDED, ENDOSCOPIC TRANSPAPILLARY AND PERCUTANEOUS GALLBLADDER DRAINAGE FOR ACUTE CHOLECYSTITIS: A SYSTEMATIC REVIEW AND NETWORK METANALYSIS

Abstract Background and Aims The optimal method of gallbladder drainage for acute cholecystitis in nonsurgical candidates is uncertain. The aim of the current study was to conduct a network meta-analysis comparing the 3 methods of gallbladder drainage (percutaneous, transpapillary, and EUS-guided). Methods A comprehensive literature search for all comparative studies assessing the efficacy of either of the 2 or all of the modalities used for treatment of acute cholecystitis in patients that were at high risk for cholecystectomy was performed. Primary outcomes of technical and clinical success and postprocedure adverse events were assessed. Secondary outcomes include reintervention, unplanned readmissions, recurrent cholecystitis, and mortality. Results Ten studies were identified, comprising 1267 patients (472 EUS-GBD, 493 PT-GBD, 302 ETP-GBD). In the network ranking estimate, PT-GBD and EUS-GBD had highest likelihood of technical success (EUS-GBD vs PT-GBD vs ETP-GBD = 2.00 vs 1.02 vs 2.98) and clinical success (EUS-GBD vs PT-GBD vs ETP-GBD = 1.48 vs 1.55 vs 2.98). EUS-GBD had lowest risk of recurrent cholecystitis (EUS-GBD vs PT-GBD vs ETP-GBD = 1.089 vs 2.02 vs 2.891). PT-GBD has highest risk of reintervention (EUS-GBD vs PT-GBD vs ETP-GBD = 1.81 vs 2.99 vs 1.199) and unplanned readmissions (EUS-GBD vs PT-GBD vs ETP-GBD = 1.582 vs 2.944 vs 1.474) whereas ETP-GBD drainage was associated with lowest rates of mortality (EUS-GBD vs PT-GBD vs ETP-GBD = 2.62 vs 2.09 vs 1.29). Conclusion The 3 modalities of gallbladder drainage have their respective advantages and disadvantages. Selection of the technique will depend on available expertise. In centers with expertise in endoscopic gallbladder drainage, the techniques are preferred over PT-GBD with improved outcomes.