P4287 - Endoscopic Naso-Gallbladder Drainage Rivals Percutaneous Drainage for Clinical and Technical Success With Fewer Serious Adverse Events in Acute Cholecystitis: A Systematic Review and Meta-Analysis

Ashesh Das, MBBS¹, Venkata Dileep Kumar Veldi, MBBS², Anika Goel, ³, Dency Dineshbhai Mavani, MBBS⁴, Fariya Iqbal, MBBS⁵, Sailesh I S. Kumar, MBBS⁶, Jash Hemal. Patel, MBBS⁷, Noorul Hidhaya, MBBS⁸, Emil Vergis Philip, MBBS⁹, Sri Sai Sampath Chalicheemala, MBBS¹⁰, Sagar M. Modi, MBBS¹¹
1KPC Medical College and Hospital , Kolkata, India, Kolkata, West Bengal, India; 2Gayatri Vidya Parishad Institute of Health care and Medical Technology, Visakhapatnam, Andhra Pradesh, India; 3Kakatiya Medical College, Warangal, Warangal, Telangana, India; 4Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India; 5Dalian Medical University, Jersey City, NJ; 6Madras medical college, Birmingham, AL; 7Government Medical College, Surat, Surat, Gujarat, India; 8Stanley Medical College, Chennai, Tamil Nadu, India; 9Madras Medical College, Kottayam, Kerala, India; 10NRI Medical college, Guntur, Guntur, Andhra Pradesh, India; 11Smt. NHL Municipal Medical College, Edison, NJ

Introduction: Emergent gallbladder drainage is life-saving for high-risk patients with acute cholecystitis, yet the optimal route remains controversial. While percutaneous transhepatic gallbladder drainage (PTGBD) is guideline-endorsed, it carries tube-related morbidity and hinders early oral intake. Endoscopic nasogallbladder drainage (ENGBD) offers an internal, tube-free alternative but lacks definitive comparative evidence. This Systematic Review and Meta Analysis clarifies whether ENGBD can match—or surpass—PTGBD in efficacy and safety.

Methods: A systematic search of PubMed, Embase, Scopus, and Cochrane Library identified Randomized Controlled Trials (RCTs) PTGBD with ENGBD in acute cholecystitis through May 2025. Data were analysed using RevMan 4.2.1. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using Mantel-Haenszel methods. Random- or fixed-effects models were applied based on heterogeneity (Higgins’ I²). Statistical significance was set at p < 0.05. Risk of bias was assessed using RoB 2.0.

Results: Across 4 RCTs encompassing 296 patients with acute cholecystitis, endoscopic nasogallbladder drainage (ENGBD) delivered the same therapeutic benefits as percutaneous transhepatic gallbladder drainage (PTGBD). Clinical success was virtually identical (ENGBD 96.0 % vs PTGBD 95.3 %; RR 1.01, 95 % CI 0.95–1.06; I² = 0 %), and technical success mirrored this equivalence (97.7 % vs 98.3 %; RR 0.97, 95 % CI 0.92–1.02; I² = 0 %). A pooled random-effects model of three trials (n = 276) showed a numerically lower rate of serious adverse events with ENGBD (13.9 % vs 26.1 %), but the reduction did not reach statistical significance (RR 0.59, 95 % CI 0.22–1.54; I² = 59 %).

Discussion: Our study shows ENGBD as a viable first-line drainage strategy, particularly attractive when percutaneous access is challenging or tube intolerance is a concern i.e in high risk patients. Adoption could streamline recovery and improve patient comfort without sacrificing outcomes. Only persons experienced at this procedure/advanced endoscopy and/or at centers of excellence should be performing this procedure. Larger, head-to-head RCTs are now warranted to confirm the observed safety signal and guide guideline updates.


Figure: Figure Showing Forest Plot of Clinical Success , Technical Success and Serious Procedure Related Adverse Events

Disclosures:
Ashesh Das indicated no relevant financial relationships.
Venkata Dileep Kumar Veldi indicated no relevant financial relationships.
Anika Goel indicated no relevant financial relationships.
Dency Dineshbhai Mavani indicated no relevant financial relationships.
Fariya Iqbal indicated no relevant financial relationships.
Sailesh Kumar indicated no relevant financial relationships.
Jash Patel indicated no relevant financial relationships.
Noorul Hidhaya indicated no relevant financial relationships.
Emil Vergis Philip indicated no relevant financial relationships.
Sri Sai Sampath Chalicheemala indicated no relevant financial relationships.
Sagar Modi indicated no relevant financial relationships.

Ashesh Das, MBBS¹, Venkata Dileep Kumar Veldi, MBBS², Anika Goel, ³, Dency Dineshbhai Mavani, MBBS⁴, Fariya Iqbal, MBBS⁵, Sailesh I S. Kumar, MBBS⁶, Jash Hemal. Patel, MBBS⁷, Noorul Hidhaya, MBBS⁸, Emil Vergis Philip, MBBS⁹, Sri Sai Sampath Chalicheemala, MBBS¹⁰, Sagar M. Modi, MBBS¹¹. P4287 - Endoscopic Naso-Gallbladder Drainage Rivals Percutaneous Drainage for Clinical and Technical Success With Fewer Serious Adverse Events in Acute Cholecystitis: A Systematic Review and Meta-Analysis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.