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The following is a summary of “Outcomes of Interval Cholecystectomy Following Endoscopic Ultrasound-guided Gallbladder Drainage: A Systematic Review and Meta-Analysis,” published in the February 2025 issue of the Gastrointestinal Endoscopy by Arayakarnkul et al.

Cholecystectomy (CCY) remains the gold standard treatment for acute cholecystitis (AC); however, endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) serves as a viable alternative for patients deemed unsuitable for surgery. While interval CCY following EUS-GBD is generally not recommended due to the formation of cholecystoenteric fistula, which complicates surgical intervention, limited data exist on its feasibility and safety. This systematic review and meta-analysis aimed to evaluate the outcomes of interval CCY following EUS-GBD, focusing on procedural success, surgical techniques, and associated adverse events. A comprehensive literature search was conducted across multiple electronic databases to identify studies reporting interval CCY outcomes after EUS-GBD. 

The primary outcomes analyzed included the pooled proportion of successful interval CCY and the distribution of surgical approaches (laparoscopic, open, and conversion from laparoscopic to open). Secondary outcomes included AEs associated with the procedure. A meta-analysis of proportions was performed using a random-effects model, and the I² statistic was used to assess heterogeneity among studies. Out of 1,001 screened citations, 15 studies comprising a total of 707 patients met the inclusion criteria. The pooled proportion of successful interval CCY was 32.9% (95% [CI]: 11.8–53.9%; I² = 99%), indicating significant variability across studies. Laparoscopic CCY was performed in 76.2% of cases (95% CI: 61.5–91.0%; I² = 82%), while open CCY was required in 14.5% (95% CI: 4.2–24.8%; I² = 82%). Additionally, 14% of patients initially undergoing laparoscopic CCY required conversion to open surgery (95% CI: 4.1–23.8%; I² = 77%). 

The pooled proportion of overall AEs was 13.2% (95% CI: 4.3–22.1%; I² = 61%), with postoperative infections occurring in 7.6% (95% CI: 0.7–14.6%; I² = 65%). Importantly, no procedure-related mortality was reported. These findings suggest that interval CCY following EUS-GBD is technically feasible and generally safe. However, it is associated with a relatively high rate of conversion to open surgery and postoperative infections. Given the technical complexity introduced by the presence of a cholecystoenteric fistula, careful patient selection remains crucial. Endoscopists should consider the availability of experienced surgical expertise in patients who may later become candidates for surgery before opting for EUS-GBD. Further prospective studies are warranted to establish standardized protocols and optimize patient outcomes.

Source: giejournal.org/article/S0016-5107(25)00143-9/abstract