Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA.
Clinical Research Centre, The Seventh Affiliated Hospital, Sun Yat-sun University. Shenzhen, China.
Gastrointest Endosc. 2021 Apr;93(4):797-804.e1. doi: 10.1016/j.gie.2020.09.040. Epub 2020 Sep 25.
The optimal method of gallbladder drainage (GBD) for acute cholecystitis in nonsurgical candidates is uncertain. The aim of the current study was to conduct a network meta-analysis comparing the 3 methods of GBD (percutaneous [PT], endoscopic transpapillary [ETP], and EUS-guided).
A comprehensive literature search for all comparative studies assessing the efficacy of either 2 or all modalities used for treatment of acute cholecystitis in patients at high risk for cholecystectomy was performed. Primary outcomes of technical and clinical success and postprocedure adverse events were assessed. Secondary outcomes were reintervention, unplanned readmissions, recurrent cholecystitis, and mortality.
Ten studies were identified, comprising 1267 patients (472 EUS-GBD, 493 PT-GBD, and 302 ETP-GBD). In the network ranking estimate, PT-GBD and EUS-GBD had the highest likelihood of technical success (EUS-GBD vs PT-GBD vs ETP-GBD: 2.00 vs 1.02 vs 2.98) and clinical success (EUS-GBD vs PT-GBD vs ETP-GBD: 1.48 vs 1.55 vs 2.98). EUS-GBD had the lowest risk of recurrent cholecystitis (EUS-GBD vs PT-GBD vs ETP-GBD: 1.089 vs 2.02 vs 2.891). PT-GBD had the highest risk of reintervention (EUS-GBD vs PT-GBD vs ETP-GBD: 1.81 vs 2.99 vs 1.199) and unplanned readmissions (EUS-GBD vs PT-GBD vs ETP-GBD: 1.582 vs 2.944 vs 1.474), whereas ETP-GBD was associated with the lowest rates of mortality (EUS-GBD vs PT-GBD vs ETP-GBD: 2.62 vs 2.09 vs 1.29).
The 3 modalities of GBD have their respective advantages and disadvantages. Selection of technique will depend on available expertise. In centers with expertise in endoscopic GBD, the techniques are preferred over PT-GBD with improved outcomes. (Clinical trial registration number: CRD42020181972.).
对于非手术候选者的急性胆囊炎，最佳的胆囊引流（GBD）方法仍不确定。本研究的目的是通过网络荟萃分析比较 3 种 GBD 方法（经皮[PT]、经内镜逆行胰胆管造影术[ETP]和超声内镜引导下）。
对所有评估高风险胆囊切除术患者急性胆囊炎治疗中使用的 2 种或所有方式疗效的比较研究进行了全面的文献检索。主要结局为技术和临床成功率以及术后不良事件。次要结局为再介入、非计划再入院、复发性胆囊炎和死亡率。
确定了 10 项研究，共纳入 1267 名患者（472 名超声内镜引导下 GBD、493 名经皮 GBD 和 302 名 ETP-GBD）。在网络排名估计中，PT-GBD 和 EUS-GBD 具有最高的技术成功率（EUS-GBD 与 PT-GBD 与 ETP-GBD：2.00 与 1.02 与 2.98）和临床成功率（EUS-GBD 与 PT-GBD 与 ETP-GBD：1.48 与 1.55 与 2.98）。EUS-GBD 复发性胆囊炎的风险最低（EUS-GBD 与 PT-GBD 与 ETP-GBD：1.089 与 2.02 与 2.891）。PT-GBD 再介入的风险最高（EUS-GBD 与 PT-GBD 与 ETP-GBD：1.81 与 2.99 与 1.199）和非计划再入院（EUS-GBD 与 PT-GBD 与 ETP-GBD：1.582 与 2.944 与 1.474），而 ETP-GBD 死亡率最低（EUS-GBD 与 PT-GBD 与 ETP-GBD：2.62 与 2.09 与 1.29）。
3 种 GBD 方式各有优缺点。技术的选择将取决于可用的专业知识。在具有内镜 GBD 专业知识的中心，这些技术优于 PT-GBD，可改善结局。（临床试验注册号：CRD42020181972。）
