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KMID : 1143920230270010056
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Annals of Hepato-Biliary-Pancreatic Surgery
2023 Volume.27 No. 1 p.56 ~ p.62
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Outcomes of endoscopic retrograde cholangiopancreatography-guided gallbladder drainage compared to percutaneous cholecystostomy in acute cholecystitis
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Shin Yong-Beom
Sheena Shamoon
Nicole Leigh Bolick
Swethaa Manickam
Usama Sattar
Shiva Poola
Prashant Mudireddy
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Abstract
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Backgrounds/Aims: Endoscopic retrograde cholangiopancreatography-guided gallbladder drainage (ERGD) is an alternative to percutaneous cholecystostomy (PTC) for hospitalized acute cholecystitis (AC) patients.
Methods: We retrospectively analyzed propensity score matched (PSM) AC hospitalizations using the National Inpatient Sample database between 2016 and 2019 to compare the outcomes of ERGD and PTC.
Results: After PSM, there were 3,360 AC hospitalizations, with 48.8% undergoing PTC and 51.2% undergoing ERGD. There was no difference in median length of stay between the PTC and ERGD cohorts (p = 0.110). There was a higher median hospitalization cost in the ERGD cohort, $62,562 (interquartile range [IQR] $40,707?97,978) compared to PTC, $40,413 (IQR $25,244?65,608; p < 0.001). The 30-day inpatient mortality was significantly lower in hospitalizations with ERGD compared to PTC (adjusted hazard ratio 0.16, 95% confidence interval [CI]: 0.1?0.41; p < 0.001). There was no difference in association with blood transfusions, acute renal failure, ileus, small bowel obstruction, and open cholecystectomy conversion (p > 0.05) between hospitalizations with ERGD and PTC. There was lower association of acute hypoxic respiratory failure (adjusted ratio [AOR] 0.46, 95% CI: 0.29?0.72; p = 0.001), hypovolemia (AOR 0.66, 95% CI: 0.49?0.82; p = 0.009) and higher association of lower gastrointestinal bleed (AOR 1.94, 95% CI: 1.48?2.54; p < 0.001) with ERGD compared to PTC.
Conclusions: ERGD is a safer alternative to PTC in patients with AC. The risk complications are lower in ERGD compared to PTC but no difference exists based on mortality or conversion to open cholecystectomy.
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KEYWORD
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Cholecystostomy, Cholangiopancreatography, endoscopic retrograde, Inpatients, Cholecystitis, acute, Health care costs
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