RESUMO
BACKGROUND: Recent evidence suggests that endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is an effective and safe alternative to percutaneous drainage (PT-GBD). We conducted a systematic review and meta-analysis to compare these two procedures in high risk surgical patients with acute cholecystitis. METHODS: A comprehensive electronic literature search was conducted for all articles published up to October 2017 to identify comparative studies between EUS-GBD and PT-GBD. A meta-analysis was performed on outcomes including technical success, clinical success, post-procedure adverse events, length of hospital stay, unplanned hospital readmission, need for reintervention, recurrent cholecystitis, and disease- or treatment-related mortality for these two procedures. RESULTS: Five comparative studies (206 patients in the EUS-GBD group vs. 289 patients in the PT-GBD group), were included in the final analysis. There were no statistically significant differences in technical success (odds ratio [OR] 0.43, 95â% confidence interval [CI] 0.12 to 1.58; P â=â0.21; I 2â=â0â%) and clinical success (OR 1.07, 95â%CI 0.36 to 3.16; P â=â0.90; I 2â=â44â%) between the two procedures. EUS-GBD had fewer adverse events than PT-GBD (OR 0.43, 95â%CI 0.18 to 1.00; P â=â0.05; I 2â=â66â%). Moreover, patients undergoing EUS-GBD had shorter hospital stays, with pooled standard mean difference of -â2.53 (95â%CIâ-â4.28 to -â0.78; Pâ=â0.005; I 2â=â98â%), and required significantly fewer reinterventions (OR 0.16, 95â%CI 0.04 to 0.042; Pâ<â 0.001; I 2â=â32â%) resulting in significantly fewer unplanned readmissions (OR 0.16, 95â%CI 0.05 to 0.53; P â=â0.003; I 2â=â79â%). CONCLUSIONS: EUS-GBD was associated with lower rates of post-procedure adverse events, shorter hospital stays, and fewer reinterventions and readmissions compared with PT-GBD in patients with acute cholecystitis who were unfit for surgery.