S209 Endoscopic Naso-Gallbladder Drainage Rivals Percutaneous Drainage for Clinical and Technical Success With Fewer Serious Adverse Events in Acute Cholecystitis: A Systematic Review and Meta-Analysis

Introduction: Emergent gallbladder drainage is life-saving for high-risk patients with acute cholecystitis, yet the optimal route remains controversial. While percutaneous transhepatic gallbladder drainage (PTGBD) is guideline-endorsed, it carries tube-related morbidity and hinders early oral intake. Endoscopic nasogallbladder drainage (ENGBD) offers an internal, tube-free alternative but lacks definitive comparative evidence. This systematic review and meta-analysis clarifies whether ENGBD can match—or surpass—PTGBD in efficacy and safety. Methods: A systematic search of PubMed, Embase, Scopus, and Cochrane Library identified randomized controlled trials (RCTs) PTGBD with ENGBD in acute cholecystitis through May 2025. Data were analysed using RevMan 4.2.1. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using Mantel-Haenszel methods. Random- or fixed-effects models were applied based on heterogeneity (Higgins’ I²). Statistical significance was set at P < 0.05. Risk of bias was assessed using RoB 2.0. Results: Across 4 RCTs encompassing 296 patients with acute cholecystitis, ENGBD delivered the same therapeutic benefits as PTGBD. Clinical success was virtually identical (ENGBD 96.0% vs PTGBD 95.3%; RR 1.01, 95% CI 0.95–1.06; I² = 0%), and technical success mirrored this equivalence (97.7% vs 98.3%; RR 0.97, 95% CI 0.92–1.02; I² = 0%). A pooled random-effects model of 3 trials (n = 276) showed a numerically lower rate of serious adverse events with ENGBD (13.9% vs 26.1%), but the reduction did not reach statistical significance (RR 0.59, 95% CI 0.22–1.54; I² = 59%). Conclusion: Our study shows ENGBD as a viable first-line drainage strategy, particularly attractive when percutaneous access is challenging or tube intolerance is a concern i.e in high-risk patients. Adoption could streamline recovery and improve patient comfort without sacrificing outcomes. Only people experienced at this procedure/advanced endoscopy and/or at centers of excellence should be performing this procedure. Larger, head-to-head RCTs are now warranted to confirm the observed safety signal and guide guideline updates.