Efficacy of Endoscopic Gallbladder Drainage in Patients with Acute Cholecystitis

Abstract Background. Early cholecystectomy is recommended for patients with acute cholecystitis. However, emergency surgery may not be indicated due to complications and disease severity. Patients requiring drainage are usually treated with percutaneous transhepatic gallbladder drainage (PTGBD), whereas patients with biliary duct stones undergo endoscopic stones removal followed by endoscopic gallbladder drainage (EGBD). Herein, we investigated the efficacy of EGBD in patients with acute cholecystitis.Methods. Overall, 101 patients receiving laparoscopic cholecystectomy between September 2019 and September 2020 in our department were retrospectively analyzed.Results. The patients (n = 101) were divided into three groups: control group that did not undergo drainage (n = 67), a group that underwent EGBD (n = 7), and a group that underwent PTGBD (n = 27). Average surgery time was 124.0, 191.9, and 150.7 minutes, respectively. Control group had a significantly shorter surgery time, whereas it did not significantly differ between EGBD and PTGBD groups. The average amount of bleeding was 11.8 g, 7.1 g, and 30.6 g, respectively, and control group had significantly less bleeding than PTGBD group. We further divided patients into the following subgroups: patients requiring a 5-mm clip to ligate the cystic duct, patients requiring a 10-mm clip due to the thickness of the cystic duct, patients requiring an automatic suturing device, and patients undergoing subtotal cholecystectomy due to impossible cystic duct ligation. There was no significant difference between EGBD and PTGBD regarding the clip used or the need for an automatic suturing device and subtotal cholecystectomy.Conclusion. There was no significant difference between EGBD and PTGBD groups regarding surgery time or bleeding amount when surgery was performed after gallbladder drainage for acute cholecystitis. Therefore, EGBD was considered a useful preoperative drainage method requiring no drainage bag.