Endoscopic ultrasound-guided transmural stenting for gallbladder drainage is an emerging alternative for the treatment of acute cholecystitis in high-risk surgical patients. A variety of stents have been described, including plastic stents, self-expandable metal stents (SEMSs), and lumen-apposing metal stents (LAMSs). LAMSs represent the only specifically designed stent for transmural gallbladder drainage. A systematic review was performed to evaluate the feasibility and efficacy of EUS-guided drainage (EUS-GBD) in acute cholecystitis using different types of stents.
MethodsA computer-assisted literature search up to September 2015 was performed using two electronic databases, MEDLINE and EMBASE. Search terms included MeSH and non-MeSH terms relating to acute cholecystitis, gallbladder drainage, endoscopic gallbladder drainage, endoscopic ultrasound gallbladder drainage, alone or in combination. Additional articles were retrieved by hand-searching from references of relevant studies. Pooled technical success, clinical success, and adverse event rates were calculated.
ResultsTwenty-one studies met the inclusion criteria, and the eligible cases were 166. The overall technical success rate, clinical success rate, and frequency of adverse events were 95.8, 93.4, and 12.0 %, respectively. The technical success rate was 100 % using plastic stents, 98.6 % using SEMSs, and 91.5 % using LAMSs. The clinical success rate was 100, 94.4, and 90.1 % after the deployment of plastic stents, SEMSs, and LAMSs, respectively. The frequency of adverse events was 18.2 % using plastic stents, 12.3 % using SEMSs, and 9.9 % using LAMSs.
ConclusionsAmong the different drainage approaches in the non-surgical management of acute cholecystitis, EUS-guided transmural stenting for gallbladder drainage appears to be feasible, safe, and effective. LAMSs seem to have high potentials in terms of efficacy and safety, although further prospective studies are needed.
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Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
Andrea Anderloni & Alessandro Repici
Gastroenterology Unit, Department of Gastrointestinal Oncological Surgery, ‘S. Maria del Prato’ Hospital, Feltre, Italy
Andrea Buda & Filippo Vieceli
Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
Mouen A. Khashab
Gastroenterology and Digestive Endoscopy, ‘Nuovo Regina Margherita’ Hospital, Rome, Italy
Cesare Hassan
Humanitas University, Rozzano, Milan, Italy
Alessandro Repici
Correspondence to Andrea Anderloni.
Ethics declarations DisclosuresDr. Khashab is a consultant for Boston Scientific and Xlumena. Dr. Repici is a consultant for Boston Scientific. Drs. Anderloni, Buda, Vieceli, Hassan have no conflicts of interest or financial ties to disclose.
Electronic supplementary materialBelow is the link to the electronic supplementary material.
About this article Cite this articleAnderloni, A., Buda, A., Vieceli, F. et al. Endoscopic ultrasound-guided transmural stenting for gallbladder drainage in high-risk patients with acute cholecystitis: a systematic review and pooled analysis. Surg Endosc 30, 5200–5208 (2016). https://doi.org/10.1007/s00464-016-4894-x
Received: 29 October 2015
Accepted: 07 March 2016
Published: 08 April 2016
Issue Date: December 2016
DOI: https://doi.org/10.1007/s00464-016-4894-x
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