Ryota Sagami, MD,1 Kenji Hayasaka, MD,1 Tetsuro Ujihara, MD,1 Tomoyuki Iwaki, MD,3 Yasushi Katsuyama, MD,3 Hideaki Harada, MD,3 Hidefumi Nishikiori, MD,1 Kazunari Murakami, MD, PhD,4 Yuji Amano, MD, PhD3

1Department of Gastroenterology, Oita San-ai Medical Center, Oita, Japan, 2Department of Gastroenterology, New Tokyo Hospital, Chiba, Japan, 3Department of Gastroenterology, Urawa Kyosai Hospital, Saitama, Japan, 4Department of Gastroenterology, Faculty of Medicine, Oita University, Oita, Japan

Background/Aims: Patients with acute cholecystitis receiving antithrombotic therapy (ATT) have an increased risk of bleeding complications during surgery and percutaneous drainage. Endoscopic transpapillary gallbladder drainage (ETGBD) is recommended for such cases; however, evidence is limited.

Methods: Two hundred-seven patients with acute cholecystitis requiring some drainages were enrolled. Those who underwent ETGBD were divided into an ATT group; continuation of ATT on the day of the procedure, and a non-ATT group; discontinuation or no use of ATT. Patients with percutaneous transhepatic gallbladder drainage/ aspiration (PTGBD/A) were also classified into the PTGBD group. The primary outcome was the bleeding complication rate.

Results: Eighty-three were enrolled in ATT, 47 in Non-ATT, and 77 in PTGBD group, respectively. In ATT group, 42.2% patients were treated with continuation of multi-agent ATT. In the three-group comparison, the bleeding complication rate was lowest in ATT group (0% P=.032). Technical success rate was highest in PTGBD group (96.1% P=.048), however, the clinical success rate in ATT group with more severe-grade cholecystitis and underlying disease was similar compared to the other groups (97.1% P=.415). Complication rate of Non-ATT group was high, however, overall complication rate of ETGBD was not significantly higher than that of PTGBD group (3.1% vs 5.2% P=.474). Twelve-month stent patency rate of patients who underwent ETGBD was 69.0%.

Conclusion: ETGBD may be an ideal drainage method for patients with acute cholecystitis receiving ATT.

Keywords: Acute cholecystitis, Antithrombotic therapy, ERCP, ETGBD, PTGBD