EUS gallbladder drainage: fewer readmissions in every study, but no firm pooled answer

Design

Systematic review and meta-analysis, 1 RCT and 5 cohorts

Population

712 surgically high-risk patients with acute cholecystitis

Primary outcome

Device- or drainage-related unplanned readmission

Effect

7.0% vs 37.1%; pooled OR 0.098 (95% CI 0.008 to 1.22)

A registered meta-analysis compared endoscopic ultrasound-guided gallbladder drainage with lumen-apposing metal stents against percutaneous transhepatic drainage in surgically high-risk acute cholecystitis. Six studies were included — one randomised, five observational — with 712 patients.

Device-related unplanned readmission occurred in 7.0% after EUS drainage and 37.1% after percutaneous drainage. Every contributing study favoured EUS, but the pooled estimate with a conservative method was imprecise (OR 0.098, 0.008 to 1.22) and not robust. Technical failure was slightly more common with EUS (4.0% vs 1.0%). Clinical success and 30-day mortality were similar, with very wide intervals.

EUS drainage removes the external catheter, which matters to frail patients. But it depends on local endoscopic expertise and it can complicate later cholecystectomy. The evidence does not yet make it the universal first choice.

• Discuss drainage route with the endoscopy team before defaulting to percutaneous.
• Consider whether the patient may later be fit for cholecystectomy — a stent can complicate it.
• Percutaneous drainage remains appropriate where EUS expertise is not available.
• Plan catheter care and review if percutaneous drainage is chosen; readmissions are frequent.

Why it matters

The catheter burden of percutaneous drainage is real, and this is the best current summary of the alternative.

Don't overread it

Certainty was very low; the pooled readmission interval crossed 1 and the result was not robust.

The statistics, in plain English

An interval running from 0.008 to 1.22 means the data are compatible with a very large benefit or none at all. The Hartung-Knapp method widens intervals when studies are few and differ, which is appropriate here. Consistency across studies is encouraging but most were observational.

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