Endoscopic nasogallbladder tube or stent placement in acute cholecystitis: a preliminary prospective randomized trial in Japan (with videos)

BackgroundThere are currently no prospective, controlled trials of endoscopic transpapillary gallbladder drainage in patients with acute cholecystitis.ObjectiveWe evaluated the technical success rate and efficacy of endoscopic transpapillary gallbladder drainage by using either endoscopic nasogallbladder drainage (ENGBD) or endoscopic gallbladder stenting (EGBS) for patients with acute cholecystitis.DesignRandomized, controlled study.SettingTertiary-care referral centers.PatientsSeventy-three consecutive patients with acute cholecystitis were randomized.InterventionsENGBD by using a 5F or 7F tube (n = 37) or EGBS (n = 36) by using a 7F stent.Main Outcome and MeasurementsTechnical success, clinical success, adverse events, and procedure-related pain score.ResultsThe overall technical success rates in the ENGBD and EGBS groups were 91.9% and 86.1%, respectively (P > .05). The mean procedure times of ENGBD and EGBS were 20.3 ± 12.1 and 22.2 ± 14.5 minutes, respectively (P > .05). The overall clinical success rates by per protocol analysis were 94.1% and 90.3% in the ENGBD and EGBS groups, respectively, whereas the rates by intention-to-treat analysis were 86.5% and 77.8%, respectively (P > .05). Moderate adverse events were observed in the ENGBD (n = 2) and EGBS (n = 1) groups. The mean visual analog score of postprocedure pain in the ENGBD group was significantly higher than that in the EGBS group (1.3 ± 1.1 vs 0.4 ± 0.8, respectively; P < .001).LimitationsSmall sample size and the participation of multiple endoscopists who may have different levels of experience in endoscopic transpapillary gallbladder drainage.ConclusionsBoth ENGBD and EGBS appear to be suitable for the treatment of acute cholecystitis in patients who are poor candidates for emergency cholecystectomy. (Clinical trial registration number: UMIN000012316.)