Abstract
Background:
Acute cholecystitis is typically managed with cholecystectomy. However, in patients with underlying co-morbidities who are not suitable for surgery, drainage procedures are recommended. Traditionally, these procedures have been performed percutaneously, but endoscopic techniques have gained popularity in recent years due to their physiological approach and lower complication rates.
Aims:
This study aims to compare endoscopic modalities of drainage (nasobiliary and internal drainage with stenting) in patients with acute cholecystitis and acute cholangitis. We also compared percutaneous drainage with endoscopic retrograde drainage procedures.
Methods:
We analyzed the National Inpatient Sample (NIS) database (2016-2020) to compare outcomes of acute cholecystitis and cholangitis patients undergoing endoscopic nasobiliary drainage and stent placement. Differences in outcomes between percutaneous and various endoscopic drainages were highlighted. Statistical significance was assessed using χ² and t-tests for categorical and continuous data respectively, with P<0.05 considered significant. Multivariate analyses were performed to assess study outcomes and adverse events for each procedure.
Results:
Patients subjected to nasobiliary drainage exhibited a higher mean age compared to those undergoing internal drainage (68.56 +/- 1.84 years vs 64.62 +/- 0.39 years, p-value < 0.05). Both groups shared similar demographic parameters and comorbidities. Internal drainage with stenting correlated with elevated incidences of acute pancreatitis (14.68% vs 13.04%, p-value <0.05) and intestinal perforation (4.24% vs 2.17%, p-value <0.05) compared to nasobiliary drainage. Conversely, nasobiliary drainage was associated with increased occurrences of bleeding (2.17% vs 0.98%, p-value < 0.05) and ileus (10.87% vs 5.22%, p-value < 0.05). Additionally, internal drainage with stenting exhibited a higher rate of subsequent cholecystectomy compared to nasobiliary drainage (3.20% vs 2.17%, p-value < 0.05).
Percutaneous drainage predominated among older individuals (70.36 +/- 0.16 years vs 64.15 +/-0.35, p-value < 0.05). The adjusted odds ratio for mortality for percutaneous drainage versus endoscopic drainage was (5.15 +/- 0.88 vs 0.2 +/- 0.03, p-value < 0.05). Those undergoing endoscopic drainage demonstrated a substantially higher rate of subsequent cholecystectomy (26.50% vs 0.24%, p-value < 0.05).
Conclusion:
Patients undergoing nasobiliary or internal drainage with stent shared similar demographic characteristics and comorbidities. Internal drainage with stenting correlated with a heightened risk of acute pancreatitis and intestinal perforation, whereas bleeding and ileus were more prevalent with nasobiliary drainage. Moreover, internal drainage with stent was associated with a higher incidence of subsequent cholecystectomy.