Francesca Margherita Bunino (Rozzano / IT), Matteo Cimino (Rozzano / IT; Milan / IT), Alessandro Fugazza (Rozzano / IT), Giulia Mauri (Rozzano / IT; Pieve Emanuele / IT), Martina Ceolin (Rozzano / IT), Simona Mei (Rozzano / IT), Enrico Marrano (Sabadell / DE), Ezio Lanza (Rozzano / IT), Andrea Anderloni (Rozzano / IT; Pavia / IT), Daniele Del Fabbro (Rozzano / IT), Hayato Kurihara (Milan / IT)
Abstract text (incl. references and figure legends)
B: Acute cholecystitis (AC) is a frequent cause of admission at the emergency department but for frail and old patients, surgery is not always feasible. Percutaneous drainage (PT-GBD) and more recently endosonographic guided drainage (EUS-GBD) are gaining popularity as palliative or definitive treatments. The aim of the present study was to compare non-surgical (NS) and surgical (S) procedures.
M: A five-year monocentic retrospective study was conducted, including patients ≥65 years old that underwent an urgent procedure. The S group included laparoscopic [LC] and open [OC] approach while NS PT-GBD and EUS-GBD. A descriptive analysis was carried out comparing the 2 groups and a subgroup analysis was added to compare PT-GBD and EUS-GBD.
R:162 patients were included: 106 S (81 LC and 25 OC) and 54 NS (21 EUS-GBD and 33 PT-GBD). A statistically significant difference was encountered for Age, Charlson Comorbidity Index (CCI), Clinical Frailty score (CFS) and ACS risk score. NS patients were older, frailer and with a higher ACS risk. Moreover, they had more likely experienced a previous AC attack and they took more anticoagulants. In all cases of NS the procedure was successfully completed (Technical failure1,9%,p=0,73). No statistically significant difference was outlined for the overall complication rate (24,5% S vs 27,8% NS, p=0,8) but NS patients had more serious complications (CD>3)(p=0,022) and they stayed longer at the hospital (5 days S vs 11 NS, p=0,011). Lastly, 90-day mortality was 4,5% in S and 9,8 in NS (p=0,066). From the subgroup analysis EUS-GBD patients resulted in having less overall and serious complications when compared to PT-GBD (respectively 39.4%vs9.5% and 27,3vs4,8%)(p<0,001). The clinical success was obtained in 85,7%(vs63,6) (p=0,002) and Recurrence (R) was 14,3%(vs 21,9)(p<0,001).
C: Even if surgery still represents the gold standard for AC, EUS-GBD is a good alternative to PT-GBD in terms of clinical success, R and complication rate.
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