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
Processing time: 110 Days and 9 Hours
ARTICLE HIGHLIGHTS
Research background

Percutaneous gallbladder drainage has been the standard treatment of acute cholecystitis in patients who are not surgical candidates. Our study sought to evaluate the efficacy and safety of transpapillary drainage for acute cholecystitis in this subset of patients.

Research motivation

The key topics of interest include non-surgical, less-invasive techniques to treat acute cholecystitis. The evolution of safe and effective treatments in acute cholecystitis can lead to improved patient outcomes and quality of life following treatment. Future research can also have a positive effect on cost effectiveness and health care utilization.

Research objectives

The main objectives were to evaluate feasibility, efficacy and safety of transpapillary gallbladder drainage in inoperable patients for the treatment of acute cholecystitis. This can positively affect further research and direct comparison trials.

Research methods

A systematic review was performed followed by updated meta-analysis.

Research results

The pooled technical success rate of endoscopic transpapillary gallbladder drainage (ETGBD) 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).

Research conclusions

Our results demonstrated that transpapillary gallbladder drainage for treatment of acute cholecystitis is both an efficacious and safe procedure in patients that are inoperable. This particular method of gallbladder drainage may offer an alternative to a certain subset of inoperable patients who are otherwise not candidates for percutaneous drainage. Patients who demonstrate signs of concomitant choledocholithiasis or cholangitis also benefit. Comparison between percutaneous drainage, and endoscopic drainage methods with endoscopic ultrasound or a transpapillary approach has been explored however results remain inconclusive.

Research perspectives

Future research should involve randomized controlled trials to compare the different non-surgical techniques used in treatment of acute cholecystitis. In regards to ETGBD, emphasis should be placed on different stenting methods, along with assessment of long term outcomes.