Seong-Hun Kim, Se Woo Park, Hyung Ku Chon, Eui Joo Kim, Jung Wan Choe, Dong Kee Jang, Yun Nah Lee, Eunae Cho, Dongwook Oh
Both approaches achieved high procedural success within their respective distinct pathways. Prior PTGBD did not appear to compromise subsequent EUS-GBD, suggesting that cEUS-GBD may serve as a valid internalization option in selected patients after initial PTGBD. The shorter procedure time with pEUS-GBD should be interpreted as a workflow-related finding, and the index gallbladder drainage modality should be individualized according to clinical stability, anatomic feasibility, and available endoscopic resources.
BACKGROUND: Percutaneous transhepatic gallbladder drainage (PTGBD) is performed for acute cholecystitis in surgically unfit patients; however, there is a risk of recurrence after tube removal. We aimed to evaluate clinical outcomes of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) across two distinct pathways - primary EUS-GBD (pEUS-GBD) and conversion from PTGBD as an internalization strategy (cEUS-GBD).
METHODS: This multicenter retrospective study included 239 surgically unfit patients with acute cholecystitis who underwent pEUS-GBD (n = 180) or cEUS-GBD (n = 59). The primary outcome was pathway-defined procedural success: initial drainage success for pEUS-GBD and internalization success for cEUS-GBD. Propensity-score overlap weighting was applied.
RESULTS: Procedural success was high in both groups (95.6% vs. 93.2%; P = 0.50). Mean (SD) procedure time was significantly shorter for pEUS-GBD (8.4 [6.6] vs. 12.9 [7.1] minutes; P < 0.001). Early adverse events did not differ significantly between the groups (10.6% vs. 11.9%; P = 0.78). Among successful cases, late adverse events (4.1% vs. 7.3%; P = 0.47) and recurrence (5 cases [2.9%] vs. 0 cases [0%]) did not differ significantly. Findings were generally consistent after overlap weighting, and mean procedure time remained shorter with pEUS-GBD (7.4 [2.8] vs. 12.0 [5.1] minutes; P < 0.001).
CONCLUSIONS: Both approaches achieved high procedural success within their respective distinct pathways. Prior PTGBD did not appear to compromise subsequent EUS-GBD, suggesting that cEUS-GBD may serve as a valid internalization option in selected patients after initial PTGBD. The shorter procedure time with pEUS-GBD should be interpreted as a workflow-related finding, and the index gallbladder drainage modality should be individualized according to clinical stability, anatomic feasibility, and available endoscopic resources.