Assuntos
Colecistectomia Laparoscópica/métodos , Colecistite Aguda , Drenagem , Endossonografia/métodos , Vesícula Biliar , Fístula Intestinal , Idoso , Colecistite Aguda/complicações , Colecistite Aguda/diagnóstico , Colecistite Aguda/cirurgia , Drenagem/efeitos adversos , Drenagem/métodos , Tratamento Farmacológico/métodos , Duodeno/cirurgia , Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/lesões , Vesícula Biliar/patologia , Vesícula Biliar/cirurgia , Gangrena/etiologia , Gangrena/cirurgia , Humanos , Fístula Intestinal/diagnóstico , Fístula Intestinal/etiologia , Fístula Intestinal/cirurgia , Masculino , Síndromes Mielodisplásicas/complicações , Síndromes Mielodisplásicas/tratamento farmacológico , Peritonite/etiologia , Peritonite/terapia , Ruptura/diagnóstico , Ruptura/etiologia , Ruptura/cirurgia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Técnicas de Fechamento de FerimentosRESUMO
INTRODUCTION: Cholecystectomy (CCY) is the gold standard treatment of acute cholecystitis (AC). Nonsurgical management of AC includes percutaneous transhepatic gallbladder drainage (PT-GBD) and endoscopic ultrasound-guided gallbladder drainage (EUS-GBD). This study aims to compare outcomes of patients who undergo CCY after having received EUS-GBD vs PT-GBD. METHODS: A multicenter international study was conducted in patients with AC who underwent EUS-GBD or PT-GBD, followed by an attempted CCY, between January 2018 and October 2021. Demographics, clinical characteristics, procedural details, postprocedure outcomes, and surgical details and outcomes were compared. RESULTS: One hundred thirty-nine patients were included: EUS-GBD in 46 patients (27% male, mean age 74 years) and PT-GBD in 93 patients (50% male, mean age 72 years). Surgical technical success was not significantly different between the 2 groups. In the EUS-GBD group, there was decreased operative time (84.2 vs 165.4 minutes, P < 0.00001), time to symptom resolution (4.2 vs 6.3 days, P = 0.005), and length of stay (5.4 vs 12.3 days, P = 0.001) compared with the PT-GBD group. There was no difference in the rate of conversion from laparoscopic to open CCY: 5 of 46 (11%) in the EUS-GBD arm and 18 of 93 (19%) in the PT-GBD group ( P value 0.2324). DISCUSSION: Patients who received EUS-GBD had a significantly shorter interval between gallbladder drainage and CCY, shorter surgical procedure times, and shorter length of stay for the CCY compared with those who received PT-GBD. EUS-GBD should be considered an acceptable modality for gallbladder drainage and should not preclude patients from eventual CCY.