Evaluation and comparison of 3 preoperative drainage methods for acute cholecystitis

Background and Objectives: In some cases of acute cholecystitis, preoperative drainage may be necessary, depending on the patient’s condition. We compared the results of 3 preoperative drainage methods, endoscopic transpapillary gallbladder drainage (ETGBD), EUS-guided biliary drainage (EUS-GBD), and percutaneous transhepatic gallbladder drainage (PTGBD), to determine the optimal drainage method. Methods: ETGBD was performed in 138 patients, EUS-GBD in 17, and PTGBD in 45. Results: The technical success rate of ETGBD was 87.0%, 94.1% for EUS-GBD, and 100% for PTGBD. ETGBD was associated with a significantly shorter time to white blood cell normalization ( P = 0.02) and oral intake initiation ( P < 0.01) compared with PTGBD and a shorter time to temporary discharge ( P < 0.01) compared with EUS-GBD and PTGBD. A total of 114 patients underwent elective laparoscopic cholecystectomy (Lap-C). The waiting period before surgery was significantly shorter in the ETGBD group ( P = 0.03) compared with the other 2 groups. There were no differences in operative time and blood loss between the 3 groups, but there were 4 cases (11.1%) of open conversion in the PTGBD group, which was a significantly higher number than that in the ETGBD group ( P = 0.02). Among the 3 groups, the adverse events rate was highest in the PTGBD group, at 9 cases (25%), and the postoperative hospital stay was shortest in the ETGBD group, at 4 days. Conclusion: Preoperative drainage as a bridging therapy for elective Lap-C should be performed in cases of acute cholecystitis, with ETGBD as the first choice and EUS-GBD as the second in cases of ETGBD failure.