Efficacy and safety of endoscopic gallbladder drainage in acute cholecystitis: Is it better than percutaneous gallbladder drainage? A systematic review and meta-analysis.

Abstract The efficacy and safety of endoscopic gallbladder drainage (EGBD) performed via endoscopic retrograde cholangiography (ERC) based transpapillary stenting or endoscopic ultrasound (EUS) based transmural stenting are unknown. We aimed to conduct a proportion meta-analysis to evaluate the cumulative efficacy and safety of these procedures and to compare them with percutaneous gallbladder drainage (PGBD). We searched several databases from inception through December 10, 2015, to identify studies (with 10 or more patients) reporting technical success and post-procedure adverse events of EGBD. Weighted pooled rates (WPR) for technical & clinical success, postprocedure adverse events and recurrent cholecystitis were calculated for both methods of EGBD. Pooled odds ratios (OR) were also calculated to compare the technical success &andpostprocedure adverse events in patients undergoing EGBD versus PGBD. The WPR with 95% confidence interval (CI) of technical success, clinical success, postprocedure adverse events and recurrent cholecystitis for ERC-based transpapillary drainage were 83% (95% CI, 78% - 87%) I(2)=38%, 93% (95% CI, 89% - 96%) I(2)=39%, 10% (95% CI, 7% - 13%) I(2)=27% and 3% (95% CI, 1% - 5%) I(2)=0%, respectively. The WPR for EUS based drainage for technical success, clinical success, postprocedure adverse events and recurrent cholecystitis were 93% (95% CI, 87% - 96%) I(2)=0%, 97% (95% CI, 93% - 99%) I(2)=0%, 13% (95% CI, 8% - 19%) I(2)=0%, 4% (95% CI, 2% - 9%) I(2)=0%. On proportionate difference, EUS-based drainage had better technical (10%) and clinical success (4%) in comparison to ERC-based drainage. Pooled OR for technical success of EGBD versus PGBD was 0.51 (95% CI, 0.09 - 2.88) I(2)=23% and pooled OR for postprocedure adverse events was 0.33 (95% CI, 0.14 - 0.80) I(2)=16% in favor of EGBD. EGBD is an efficacious and safe therapeutic modality for treatment of patients with acute cholecystitis who cannot undergo surgery. EGBD has similar technical success as PGBD, but appears to be safer than PGBD.