A comparative analysis of radiation exposure in endoscopic ultrasound‐guided drainage versus endoscopic transpapillary drainage for acute cholecystitis

Currently, reports comparing radiation exposure associated with endoscopic transpapillary gallbladder drainage (ETGBD) and endoscopic ultrasound‐guided gallbladder drainage (EUS‐GBD) for acute cholecystitis are lacking. Therefore, we aimed to evaluate the radiation exposure during ETGBD and EUS‐GBD. We retrospectively investigated patients with acute cholecystitis who underwent ETGBD or EUS‐GBD between January 2020 and September 2023. All procedures were performed using the same fluoroscopy device with an overcouch x‐ray tube. Parameters such as fluoroscopy time, number of radiographs, and estimated entrance surface dose were assessed for radiation exposure. After excluding patients with choledocholithiasis or acute cholangitis, a comparative analysis of patient characteristics and procedural outcomes was performed between the ETGBD and EUS‐GBD groups. Forty‐four patients (21 and 23 in the ETGBD and EUS‐GBD groups, respectively) were assessed. Although there was no significant difference in patients with an American Society of Anesthesiologists physical status ≥3 between the groups, the EUS‐GBD group had a higher proportion of older patients than the ETGBD group. The EUS‐GBD group demonstrated a shorter procedure time (38 vs. 59 min, p < .001), shorter fluoroscopy time (964 vs. 1829 s, p < .001), fewer radiographs (22.9 vs. 28.4 images, p < .001), and lower estimated entrance surface dose (85.2 vs. 149.3 mGy, p < .001) compared to the ETGBD group. The EUS‐GBD group had a higher procedural success rate than the ETGBD group (100% vs. 57.1%, p < .001), with no significant difference in the incidence of early adverse events (17.4% vs. 9.5%, p = .67). In patients with permanent stenting, the 1‐year cumulative incidence of symptomatic late adverse events (recurrence of acute cholecystitis and other adverse events) was significantly lower in the EUS‐GBD group than in the ETGBD group (p = .045). In patients without concurrent bile duct stones or cholangitis, EUS‐GBD demonstrated shorter procedure and fluoroscopy times, required fewer radiographs, and had a significantly higher procedural success rate than ETGBD.