The Safety and Efficacy Of Endoscopic Ultrasound-Guided Gallbladder Drainage: A Systematic Review and Meta-Analysis

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Gastrointestinal Endoscopy





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Introduction The role of endoscopic ultrasound (EUS) has expanded to invasive and advanced therapeutic procedures. One such therapeutic procedure is EUS-guided gallbladder drainage with stent placement, especially in high surgical risk patients. We aimed at doing a systematic review and meta-analysis of studies looking at the technical and clinical success rates as well as the adverse events. Methods We conducted a comprehensive search of multiple electronic databases and conference proceedings including PubMed, EMBASE, Web of Science databases, Google Scholar and manual search of references (from inception through October 2017) to identify studies that reported the EUS-guided gallbladder drainage in patients with various indications. The primary outcome was to look at the technical and clinical success of the procedure. The secondary outcome was to look at the total adverse events and sub-group analysis of 2 major complications including infection and hemorrhage. Results 21 studies reporting on 841 patients were identified which included 444 males and 367 females undergoing 841 procedures. The pooled technical success rates and clinical success rates were: 95.9% (95% CI= 91.5-98.9), I2= 77.1% and 92.5% (95% CI= 86.3 - 97.2), I2= 82.2%, respectively. The total adverse event rates were 16.3% (95% CI= 11.2-22), I2 70%. Sub-group analysis of 2 major individual adverse events were: infection rate of 0.86% (95%CI= 0.07-2.24), I2= 18.9%; bleeding rate of 0.8% (95% CI= 0.11-1.91), I2 =0%. Substantial heterogeneity was noted in the analysis. Discussion EUS-guided gallbladder drainage has a very high technical and clinical success rate and hence a very effective procedure. Concerns about publication bias exist. Careful consideration should be given to the procedure-related adverse events and weighing the risks and benefits of the alternative non-surgical/surgical approaches.





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