P0008 - Outcomes of Interval Cholecystectomy Following Endoscopic Ultrasound-Guided Gallbladder Drainage: A Systematic Review and Meta-Analysis

Suchapa Arayakarnkul, MD¹, Jacquelin Blomker, MD¹, Amir Sultan Seid, MD¹, Nicole Theis-Mahon, ¹, Natalie Wilson, MD¹, Rahul Karna, MD², Mohammad Bilal, MD^3
1University of Minnesota, Minneapolis, MN; ²University of Minnesota Medical Center, Minneapolis, MN; ³University of Minnesota and Minneapolis VA Health Care System, Minneapolis, MN

Introduction: Cholecystectomy is the gold standard for management of acute cholecystitis (AC). However, AC patients who are medically unfit for surgery at index presentation can undergo endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) for treatment of AC. EUS-GBD is typically limited to patients who will not be candidates for interval cholecystectomy as the formation of cholecystoenteric fistula can make future surgery challenging. Recent studies have suggested feasibility of EUS-GB as a bridge to subsequent surgery. We aim to conduct a systematic review and meta-analysis to determine the outcomes of interval cholecystectomy in patients with previous EUS-GBD.

Methods: We conducted a literature search of multiple electronic databases (inception-June 2024) for studies evaluating outcomes of interval cholecystectomy following EUS-GBD. Primary outcomes were pooled proportion of patients undergoing cholecystectomy, conversion rate of laparoscopic-to-open cholecystectomy, rates of open cholecystectomy and rate of adverse events (AEs). Secondary outcomes were procedural time, length of stay (LOS), and mortality. A meta-analysis of proportion was performed using the random-effects model. I² statistic was used to assess heterogeneity.

Results: Out of 1001 citations, 16 studies including 716 patients (51.8% male, mean age 71.7±14.8, mean Charlson Comorbidity Index 5.93±3.5) who had previously undergone EUS-GBD [stent site: duodenum 47.5%; stomach 27.7%; jejunum 0.7%] were analyzed. (Table 1) Pooled proportion of successful interval cholecystectomy was 0.37 (CI: 0.16-0.57; I² 99%) (Figure 1) [laparoscopic: 0.74 (CI: 0.6-0.88; I² 82%); open: 0.13 (CI: 0.04-0.22; I² 80%); laparoscopic converted to open: 0.16 (CI: 0.06-0.26; I² 77%)]. None of the studies reported aborted surgery. Interval cholecystectomy was performed after 52.8±65.5 days from the initial EUS-GBD. Pooled proportion of overall AEs was 0.16 (CI: 0.06-0.25; I² 65%), including postoperative infection: 0.1 (CI: 0.02-0.18; I² 70%). Mean procedural time was 120±67.3 minutes, with mean LOS 5.8±3.6 days. There was no procedure-related mortality.

Discussion: Our study demonstrates that interval cholecystectomy is technically safe and feasible after EUS-GBD. Nearly 75% of patients underwent successful laparoscopic cholecystectomy, with conversion to open reported in only 16%. However, these results could have a selection bias due to candidate selection for interval cholecystectomy after EUS-GBD.



Disclosures:


Suchapa Arayakarnkul, MD¹, Jacquelin Blomker, MD¹, Amir Sultan Seid, MD¹, Nicole Theis-Mahon, ¹, Natalie Wilson, MD¹, Rahul Karna, MD², Mohammad Bilal, MD³. P0008 - Outcomes of Interval Cholecystectomy Following Endoscopic Ultrasound-Guided Gallbladder Drainage: A Systematic Review and Meta-Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.