Meta-Analysis
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Aug 16, 2021; 13(8): 345-355
Published online Aug 16, 2021. doi: 10.4253/wjge.v13.i8.345
Efficacy and safety of endoscopic transpapillary gallbladder drainage in acute cholecystitis: An updated meta-analysis
David M Jandura, Srinivas R Puli
David M Jandura, Department of Gastroenterology, University of Illinois College of Medicine at Peoria, Peoria, IL 61637, United States
Srinivas R Puli, Department of Gastroenterology and Hepatology, University of Illinois College of Medicine at Peoria, Peoria, IL 61637, United States
Author contributions: Jandura DM contributed to the design, analysis, and interpretation of the data, writing of the article, and critical revision of the article; Puli SR contributed to the conception, analysis, and final approval of the article.
Conflict-of-interest statement: The authors declare no conflicts of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: David M Jandura, MD, Academic Fellow, Department of Gastroenterology, University of Illinois College of Medicine at Peoria, 530 NE Glen Oak Ave, Peoria, IL 61637, United States. djandura7@gmail.com
Received: April 23, 2021
Peer-review started: April 23, 2021
First decision: June 7, 2021
Revised: June 21, 2021
Accepted: July 5, 2021
Article in press: July 5, 2021
Published online: August 16, 2021
Abstract
BACKGROUND

Percutaneous transhepatic gallbladder drainage has been the most frequently performed treatment for acute cholecystitis for patients who are not candidates for surgery. Endoscopic transpapillary gallbladder drainage (ETGBD) has evolved into an alternative treatment. There have been numerous retrospective and prospective studies evaluating ETGBD for acute cholecystitis, though results have been variable.

AIM

To evaluate the efficacy and safety of ETGBD in the treatment of inoperable patients with acute cholecystitis.

METHODS

We performed a systematic review of major literature databases including PubMed, OVID, Science Direct, Google Scholar (from inception to March 2021) to identify studies reporting technical and clinical success, and post procedure adverse events in ETGBD. Weighted pooled rates were then calculated using fixed effects models for technical and clinical success, and post procedure adverse events, including recurrent cholecystitis.

RESULTS

We found 21 relevant articles that were then included in the study. In all 1307 patients were identified. The pooled technical success rate was 82.62% [95% confidence interval (CI): 80.63-84.52]. The pooled clinical success rate was found to be 94.87% (95%CI: 93.54-96.05). The pooled overall complication rate was 8.83% (95%CI: 7.42-10.34). Pooled rates of post procedure adverse events were bleeding 1.03% (95%CI: 0.58-1.62), perforation 0.78% (95%CI: 0.39-1.29), peritonitis/bile leak 0.45% (95%CI: 0.17-0.87), and pancreatitis 1.98% (95%CI: 1.33-2.76). The pooled rates of stent occlusion and migration were 0.39% (95%CI: 0.13-0.78) and 1.3% (95%CI: 0.75-1.99) respectively. The pooled rate of cholecystitis recurrence following ETGBD was 1.48% (95%CI: 0.92-2.16).

CONCLUSION

Our meta-analysis suggests that ETGBD is a feasible and efficacious treatment for inoperable patients with acute cholecystitis.

Keywords: Endoscopic transpapillary gallbladder drainage, Acute cholecystitis, Inoperable treatment, Double pigtail stent, Nasobiliary drainage

Core Tip: We offer the most updated meta-analysis evaluating the efficacy, feasibility and safety of endoscopic transpapillary gallbladder drainage for the treatment of inoperable acute cholecystitis. We included 21 studies in our analysis. Our results conclude that this modality of gallbladder drainage is safe and efficacious.