Takao Itoi1, Tadahiro Takada2, Tsann-Long Hwang3, Itaru Endo4, Kohei Akazawa5, Fumihiko Miura2, Miin-Fu Chen3, Yi-Yin Jan3, Chen-Guo Ker6, Hsiu-Po Wang7, Harumi Gomi8, Masamichi Yokoe9, Seiki Kiriyama10, Keita Wada2, Hiroki Yamaue11, Masaru Miyazaki12, Masakazu Yamamoto13. 1. Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan. 2. Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan. 3. Division of General Surgery, Lin-Kou Chang Gung Memorial Hospital, Tauyuan, Taiwan. 4. Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Kanagawa, Japan. 5. Department of medical informatics, Niigata University, Niigata, Japan. 6. Department of Surgery, Yuan's General Hospital, Kaohsiung, Taiwan. 7. Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan. 8. Center for Global Health Mito Kyodo General Hospital University of Tsukuba, Ibaraki, Japan. 9. Department of General Internal Medicine, Japanese Red Cross Nagoya Daini Hospital, Aichi, Japan. 10. Department of Gastroenterology, Ogaki Municipal Hospital, Gifu, Japan. 11. Second Department of Surgery, Wakayama Medical University School of Medicine, Wakayama, Japan. 12. Emeritus Professor, Graduate School of Medicine, Chiba University, Chiba, Japan. 13. Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
Abstract
BACKGROUND: Tokyo Guideline 2013 (TG13) proposed three drainage techniques for the treatment of acute cholecystitis. We evaluated the clinical efficacy and adverse events between percutaneous transhepatic intervention (PTGBI) including percutaneous transhepatic gallbladder drainage (PTGBD) and percutaneous transhepatic gallbladder aspiration (PTGBA) and endoscopic transpapillary gallbladder drainage (EGBD). METHODS: A cohort study was performed using propensity score matching to reduce treatment selection bias. This involved the analysis of collected data for 1,764 patients who underwent PTGBI and EGBD. RESULTS: Propensity score matching extracted 330 pairs of patients. The difference in the clinical success rate within 3 days between PTGBI and EGBD were 62.5% and 69.8%, respectively (P = 0.085). The differences in the suboptimal clinical success rates within 7 days between PTGBI and EGBD were 87.6% and 89.2% (P = 0.579). The differences in the complication rate between PTGBI and EGBD were 4.8% and 8.2% (P = 0.083). The differences in the complication rate among PTGBD, PTGBA and EGBD were 5.6%, 1.6% and 8.2% (P = 0.11). Median required days of PTGBD (3.0 days) was significantly longer than those of PTGBA and EGBD (1.5 and 2.0 days, respectively) (P = 0.001). CONCLUSION: The current study showed the PTGBI showed similar clinical efficacy compared with EGBD without significant discrepancy of complication rate for the treatment of acute cholecystitis.
BACKGROUND: Tokyo Guideline 2013 (TG13) proposed three drainage techniques for the treatment of acute cholecystitis. We evaluated the clinical efficacy and adverse events between percutaneous transhepatic intervention (PTGBI) including percutaneous transhepatic gallbladder drainage (PTGBD) and percutaneous transhepatic gallbladder aspiration (PTGBA) and endoscopic transpapillary gallbladder drainage (EGBD). METHODS: A cohort study was performed using propensity score matching to reduce treatment selection bias. This involved the analysis of collected data for 1,764 patients who underwent PTGBI and EGBD. RESULTS: Propensity score matching extracted 330 pairs of patients. The difference in the clinical success rate within 3 days between PTGBI and EGBD were 62.5% and 69.8%, respectively (P = 0.085). The differences in the suboptimal clinical success rates within 7 days between PTGBI and EGBD were 87.6% and 89.2% (P = 0.579). The differences in the complication rate between PTGBI and EGBD were 4.8% and 8.2% (P = 0.083). The differences in the complication rate among PTGBD, PTGBA and EGBD were 5.6%, 1.6% and 8.2% (P = 0.11). Median required days of PTGBD (3.0 days) was significantly longer than those of PTGBA and EGBD (1.5 and 2.0 days, respectively) (P = 0.001). CONCLUSION: The current study showed the PTGBI showed similar clinical efficacy compared with EGBD without significant discrepancy of complication rate for the treatment of acute cholecystitis.