1
|
Binda C, Anderloni A, Forti E, Fusaroli P, Macchiarelli R, Manno M, Fugazza A, Redaelli A, Aragona G, Lovera M, Togliani T, Armellini E, Amato A, Brancaccio ML, Badas R, Leone N, de Nucci G, Mangiavillano B, Sbrancia M, Pollino V, Lisotti A, Maida M, Sinagra E, Ventimiglia M, Repici A, Fabbri C, Tarantino I. EUS-Guided Gallbladder Drainage Using a Lumen-Apposing Metal Stent for Acute Cholecystitis: Results of a Nationwide Study with Long-Term Follow-Up. Diagnostics (Basel) 2024; 14:413. [PMID: 38396453 PMCID: PMC10887962 DOI: 10.3390/diagnostics14040413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/02/2024] [Accepted: 02/11/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Although endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using lumen-apposing metal stents (LAMS) has become one of the treatments of choice for acute cholecystitis (AC) in fragile patients, scant data are available on real-life settings and long-term outcomes. METHODS We performed a multicenter retrospective study including EUS-guided GBD using LAMS for AC in 19 Italian centers from June 2014 to July 2020. The primary outcomes were technical and clinical success, and the secondary outcomes were the rate of adverse events (AE) and long-term follow-up. RESULTS In total, 116 patients (48.3% female) were included, with a mean age of 82.7 ± 11 years. LAMS were placed, transgastric in 44.8% of cases, transduodenal in 53.3% and transjejunal in 1.7%, in patients with altered anatomy. Technical success was achieved in 94% and clinical success in 87.1% of cases. The mean follow-up was 309 days. AEs occurred in 12/116 pts (10.3%); 8/12 were intraprocedural, while 1 was classified as early (<15 days) and 3 as delayed (>15 days). According to the ASGE lexicon, two (16.7%) were mild, three (25%) were moderate, and seven (58.3%) were severe. No fatal AEs occurred. In subgroup analysis of 40 patients with a follow-up longer than one year, no recurrence of AC was observed. CONCLUSIONS EUS-GBD had high technical and clinical success rates, despite the non-negligible rate of AEs, thus representing an effective treatment option for fragile patients.
Collapse
Affiliation(s)
- Cecilia Binda
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, 47121 Forlì-Cesena, Italy; (M.S.); (C.F.)
| | - Andrea Anderloni
- Gastroenterology and Digestive Endoscopy Unit, Fondazione I.R.C.C.S., Policlinico San Matteo Viale, 27100 Pavia, Italy;
| | - Edoardo Forti
- Digestive and Interventional Endoscopy Unit, Ospedale Ca’ Granda Niguarda, 20162 Milan, Italy;
| | - Pietro Fusaroli
- Gastroenterology Unit, Hospital of Imola, University of Bologna, 40026 Imola, Italy; (P.F.); (A.L.)
| | - Raffaele Macchiarelli
- Gastroenterology Unit, A.O.U.S. Policlinico S. Maria alle Scotte, 53100 Siena, Italy;
| | - Mauro Manno
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL Modena, 41121 Modena, Italy;
| | - Alessandro Fugazza
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, IRCCS—Humanitas Research Hospital, 20089 Milan, Italy; (A.F.); (A.R.)
| | | | - Giovanni Aragona
- Gastroenterology and Hepatology Unit, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy;
| | - Mauro Lovera
- Digestive Endoscopy Unit, Fondazione Poliambulanza Istituto Ospedaliero, 25133 Brescia, Italy;
| | - Thomas Togliani
- Gastroenterology Unit, University Hospital Borgo Trento, 37126 Verona, Italy;
| | - Elia Armellini
- Digestive Endoscopy Unit, ASST Bergamo Est, 24060 Seriate, Italy;
| | - Arnaldo Amato
- Department of Gastroenterology, Valduce Hospital, 22100 Como, Italy;
| | | | - Roberta Badas
- Digestive Endoscopy Unit, University Hospital, 09123 Cagliari, Italy;
| | - Nicola Leone
- Digestive Endoscopy Unit, Humanitas Gradenigo, 10153 Turin, Italy;
| | - Germana de Nucci
- Gastroenterology and Endoscopy Unit, ASST Rhodense, 20024 Garbagnate Milanese, Italy;
| | | | - Monica Sbrancia
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, 47121 Forlì-Cesena, Italy; (M.S.); (C.F.)
| | - Valeria Pollino
- Digestive Endoscopy Unit, S. Michele Hospital, 09126 Cagliari, Italy;
| | - Andrea Lisotti
- Gastroenterology Unit, Hospital of Imola, University of Bologna, 40026 Imola, Italy; (P.F.); (A.L.)
| | - Marcello Maida
- Gastroenterology and Endoscopy Unit, S. Elia-Raimondi Hospital, 93100 Caltanissetta, Italy;
- Department of Medicine and Surgery, School of Medicine and Surgery, University of Enna ‘Kore’, 94100 Enna, Italy
| | - Emanuele Sinagra
- Gastroenterology and Endoscopy Unit, Fondazione Istituto G. Giglio, Contrada Pietrapollastra Pisciotto, 90015 Cefalù, Italy;
| | - Marco Ventimiglia
- Directorate General of Medical Device and Pharmaceutical Service, Italian Ministry of Health, 00153 Rome, Italy;
| | - Alessandro Repici
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, IRCCS—Humanitas Research Hospital, 20089 Milan, Italy; (A.F.); (A.R.)
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, 47121 Forlì-Cesena, Italy; (M.S.); (C.F.)
| | - Ilaria Tarantino
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT, 90100 Palermo, Italy;
| |
Collapse
|
2
|
Dietrich CF, Braden B, Burmeister S, Aabakken L, Arciadacono PG, Bhutani MS, Götzberger M, Healey AJ, Hocke M, Hollerbach S, Ignee A, Jenssen C, Jürgensen C, Larghi A, Moeller K, Napoléon B, Rimbas M, Săftoiu A, Sun S, Bun Teoh AY, Vanella G, Fusaroli P, Carrara S, Will U, Dong Y, Burmester E. How to perform EUS-guided biliary drainage. Endosc Ultrasound 2022; 11:342-354. [PMID: 36255022 PMCID: PMC9688140 DOI: 10.4103/eus-d-21-00188] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
EUS-guided biliary drainage (EUS-BD) has recently gained widespread acceptance as a minimally invasive alternative method for biliary drainage. Even in experienced endoscopy centers, ERCP may fail due to inaccessibility of the papillary region, altered anatomy (particularly postsurgical alterations), papillary obstruction, or neoplastic gastric outlet obstruction. Biliary cannulation fails at first attempt in 5%-10% of cases even in the absence of these factors. In such cases, alternative options for biliary drainage must be provided since biliary obstruction is responsible for poor quality of life and even reduced survival, particularly due to septic cholangitis. The standard of care in many centers remains percutaneous transhepatic biliary drainage (PTBD). However, despite the high technical success rate with experienced operators, the percutaneous approach is more invasive and associated with poor quality of life. PTBD may result in long-term external catheters for biliary drainage and carry the risk of serious adverse events (SAEs) in up to 10% of patients, including bile leaks, hemorrhage, and sepsis. PTBD following a failed ERCP also requires scheduling a second procedure, resulting in prolonged hospital stay and additional costs. EUS-BD may overcome many of these limitations and offer some distinct advantages in accessing the biliary tree. Current data suggest that EUS-BD is safe and effective when performed by experts, although SAEs have been also reported. Despite the high number of clinical reports and case series, high-quality comparative studies are still lacking. The purpose of this article is to report on the current status of this procedure and to discuss the tools and techniques for EUS-BD in different clinical scenarios.
Collapse
Affiliation(s)
- Christoph F. Dietrich
- Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China,Department of Allgemeine Innere Medizin der Kliniken (DAIM) Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland,Address for correspondence Dr. Christoph F. Dietrich, Department Allgemeine Innere Medizin, Kliniken Hirslanden Beau Site, Salem und Permancence, Bern, Switzerland. E-mail:
| | - Barbara Braden
- Translational Gastroenterology Unit, Oxford University Hospitals, Oxford, UK
| | - Sean Burmeister
- Hepato-Pancreatico-Biliary Unit, Groote Schuur Hospital, Cape Town, South Africa
| | - Lars Aabakken
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Paolo Giorgio Arciadacono
- Division of Pancreatobiliary Endoscopy and Endosonography, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Manoop S. Bhutani
- Department of Gastroenterology Hepatology and Nutrition, UTMD Anderson Cancer Center, Houston, Texas, USA
| | - Manuela Götzberger
- Department of Gastroenterology and Hepatology, München Klinik Neuperlach und Harlaching, Munich, Germany
| | | | - Michael Hocke
- Medical Department II, Helios Klinikum Meiningen, Meiningen, Germany
| | - Stephan Hollerbach
- Department of Gastroenterology, Allgemeines Krankenhaus Celle, Celle, Germany
| | - André Ignee
- Caritas-Krankenhaus, Bad Mergentheim, Germany
| | - Christian Jenssen
- Medical Department, Krankenhaus Maerkisch-Oderland, Strausberg and Brandenburg Institute of Clinical Ultrasound at Medical University Brandenburg, Neuruppin, Germany
| | | | - Alberto Larghi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Kathleen Moeller
- Department of Medical I/Gastroenterology, SANA Hospital Lichtenberg, Berlin, Germany
| | | | - Mihai Rimbas
- Department of Gastroenterology, Clinic of Internal Medicine, Colentina Clinical Hospital, Carol Davila University of Medicine, Bucharest, Romania
| | - Adrian Săftoiu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | - Siyu Sun
- Department of Endoscopy Center, Shengjing Hospital of China Medical University, Liaoning Province, China
| | - Anthony Yuen Bun Teoh
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Giuseppe Vanella
- Division of Pancreatobiliary Endoscopy and Endosonography, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Pietro Fusaroli
- Department of Medical and Surgical Sciences, Gastrointestinal Unit, University of Bologna/Hospital of Imola, Imola, Italy
| | - Silvia Carrara
- Division of Gastroenterology, Humanitas Clinical and Research Center, Digestive Endoscopy Unit, Milan, Italy
| | - Uwe Will
- Department of Gastroenterology, SRH Klinikum Gera, Gera, Germany
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Eike Burmester
- Medizinische Klinik I, Sana Kliniken Luebeck, Luebeck, Germany
| |
Collapse
|
3
|
Bass RB, Teitelbaum EN. Novel advances in surgery for Gallstone Disease. Curr Gastroenterol Rep 2022. [PMID: 35829827 DOI: 10.1007/s11894-022-00844-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 12/19/2021] [Accepted: 06/08/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE OF REVIEW Examine recent advances in the treatment of patients with complex gallstone disease. RECENT FINDINGS Laparoscopic common bile duct exploration (LCBDE) has been shown to be an effective and safe treatment for choledocholithiasis, resulting in decreased hospital length of stay and costs when compared with ERCP plus laparoscopic cholecystectomy (LC). Novel simulator-based curricula have recently been developed to address the educational gap that has resulted in an underutilization of LCBDE. Patients with cholecystitis who are too ill to safely undergo LC have traditionally been treated with percutaneous cholecystostomy (PC). Endoscopic ultrasound (EUS) guided gallbladder drainage is a novel definitive treatment for such patients and has been shown to result in decreased complications and hospital readmissions compared to PC. The management of symptomatic gallstone disease during pregnancy has evolved over the last several decades. While it is now well established that laparoscopic procedures under general anesthesia are safe throughout a pregnancy, recent studies have suggested that laparoscopic cholecystectomy during the third trimester specifically may result in higher rates of preterm labor when compared with non-operative management. Finally, indocyanine green (ICG) fluorescence cholangiography is a novel imaging modality that has been used during laparoscopic cholecystectomy and may offer better visualization of biliary anatomy during dissection when compared with traditional intraoperative cholangiography. A number of recent technological, procedural, educational, and research innovations have enhanced and expanded treatment options for patients with complex gallstone disease.
Collapse
|
4
|
Abstract
Endoscopic drainage of the gallbladder for acute cholecystitis can be performed with the transpapillary method or endoscopic ultrasound (EUS)-guided method. EUS-guided gallbladder drainage (EUS-GBD) is gaining popularity as the treatment of choice for acute cholecystitis in patients who are deemed high-risk for cholecystectomy (CCY). It provides an alternative to percutaneous drainage and laparoscopic CCY in these patients. With the development of lumen-apposing metal stents (LAMS), the procedure is associated with high rates of technical and clinical success with low rates of adverse events (AEs). The aim of this article is to provide an overview of the current status of EUS-GBD including the indications, techniques, stent systems in-use, and how the procedure compares to conventional techniques are outlined. Furthermore, the feasibility of cholecystoscopy and advanced gallbladder interventions is explored. Finally, a comparison in outcomes of EUS-GBD versus laparoscopic CCY is provided giving some initial data in support of the procedure as an alternative to surgery in a selected group of patients.
Collapse
Affiliation(s)
- Xiaobei Luo
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Reem Sharaiha
- Division of Gastroenterology and Hepatology, New York Presbyterian Hospital/Weill Cornell Medical Centre, New York, NY, USA
| | - Anthony Yuen Bun Teoh
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
| |
Collapse
|
5
|
Zhang K, Ge N, Guo J, Wang S, Sun S. Ex vivo comparison of electrocautery-enhanced delivery of lumen-apposing metal stents matching electrosurgical workstations during EUS-guided gallbladder drainage. Endosc Ultrasound 2022; 11:377-382. [PMID: 36255025 PMCID: PMC9688136 DOI: 10.4103/eus-d-21-00240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background and Objectives EUS-guided gallbladder drainage (EUS-GBD) has become one of the recommended treatments for patients with high-risk acute cholecystitis. However, the gallbladder reportedly collapsed due to bile leakage, which was a disadvantage that affects the surgical success rate. Different electrocautery-enhanced delivery of the lumen-apposing metal stents (ECE-LAMSs) using suitable power levels in electrosurgical workstations can increase the surgical success rate and reduce trauma. Therefore, we proposed the use of the ECE-LAMSs and electrosurgical workstations for the first time through ex vivo experiments to adjust the different power levels and select the most suitable electrosurgical power for each ECE-LAMS type. Methods We compared three types of ECE-LAMS (9Fr, 10.5Fr, and 10.8Fr) with three types of electrosurgical workstations during EUS-GBD. GBD was simulated ex vivo under the guidance of an ultrasound endoscope. We performed various power tests to elucidate the ideal electric power for different ECE-LAMS combined with the different types of electrosurgical workstations. Results For the 10.8Fr ECE-LAMS matched with the Martin, Erbe, and Olympus electrosurgical workstations, the ideal power levels were 200 W, 200 W, and 250W. For the 10.5Fr and 9Fr ECE-LAMS matched with the Martin, Erbe, and Olympus electrosurgical workstations, the ideal power levels were 150 W, 200 W, and 200 W. Conclusion During the operations, due to low-power levels in the electrosurgical workstations increased the number of cuts, the EUS images were obviously unclear, which affected the success rates of the operations. We suggested different power levels for the different types of LAMS and their matching electrosurgical workstations, which can increase the surgical success rates and reduce surgical injuries.
Collapse
Affiliation(s)
- Kai Zhang
- Department of Gastroenterology, Endoscopic Center, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Nan Ge
- Department of Gastroenterology, Endoscopic Center, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Jintao Guo
- Department of Gastroenterology, Endoscopic Center, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Sheng Wang
- Department of Gastroenterology, Endoscopic Center, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Siyu Sun
- Department of Gastroenterology, Endoscopic Center, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China,Address for correspondence Dr. Siyu Sun, Department of Gastroenterology, Endoscopic Center, Shengjing Hospital of China Medical University, Sanhao Street 36, Shenyang 110 004, Liaoning Province, China. E-mail:
| |
Collapse
|
6
|
Abstract
If endoscopic retrograde cholangiopancreatography (ERCP) fails in cases of biliary obstruction and jaundice, percutaneous drains have been traditionally the current second-line option. Endoscopic ultrasonography-guided biliary drainage (EUS-BD) with choledocoduodenostomy or hepaticogastrostomy is alternative modality that have shown equivalent or better technical and clinical success compared with percutaneous drainage. Similarly, EUS-guided gallbladder drainage has emerged as a therapeutic option in acute cholecystitis as well. Furthermore, EUS-BD avoids some of the pitfalls of percutaneous drainage. Current research in EUS-BD involves optimizing devices to improve technical and clinical success. In centers with advanced endoscopists trained in these procedures, EUS-BD is an excellent second-line modality.
Collapse
Affiliation(s)
- Shyam Vedantam
- Department of Medicine, University of Miami, Miami, FL, USA
| | - Sunil Amin
- Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami, 1120 NW 14th Street, Clinical Research Building, Suite 11145 (D-49), Miami, FL 33136, USA.
| |
Collapse
|
7
|
Nishiguchi K, Ogura T, Okuda A, Ueno S, Nishioka N, Yamada M, Matsuno J, Ueshima K, Yamamoto Y, Higuchi K. Endoscopic gallbladder drainage for acute cholecystitis with high-risk surgical patients between transduodenal and transpapillary stenting. Endosc Ultrasound 2021; 10:448-454. [PMID: 34782492 PMCID: PMC8785679 DOI: 10.4103/eus-d-20-00130] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
Background and Objectives: EUS-guided gallbladder drainage (GBD) has emerged as an alternative GBD technique, particularly for high-risk surgical patients. To prevent stent migration or to facilitate stent deployment, the lumen-apposing metal stent (LAMS) was recently developed for EUS-GBD. However, LAMS remains unavailable in several countries and is expensive compared with conventional fully covered self-expandable metal stent (FCSEMS). Although several studies have shown the clinical benefits of EUS-GBD using novel FCSEMS or LAMS compared with endoscopic transpapillary GBD (ETGBD), the choice between ETGBD and EUS-GBD using conventional FCSEMS and ETGBD remains controversial. The aim of this study was to evaluate EUS-GBD using conventional FCSEMS compared with ETGBD. Materials and Methods: This comparative retrospective study included consecutive symptomatic AC patients who underwent gallbladder drainage by either EUS-GBD or ETGBD between January 2015 and December 2018. The main outcome measures were technical success, clinical success, procedure-related and stent-related adverse events, and recurrence of AC during follow-up. Results: Fifty-four patients (44.4% female, 55.6% male) who underwent EUS-GBD (n = 25) or ETGBD (n = 29) were enrolled. Initial technical success rates were 100% with EUS-GBD and 82.7% (24/29) with ETGBD. The median procedure time was significantly shorter for the EUS-GBD group than for the ETGBD group (11.0 vs. 24.0 min, P < 0.05). Procedure-related adverse events did not differ significantly between groups (P = 0.283). During follow-up (median 522 days, range 43 – 1892 days), recurrent acute cholecystitis (AC) was only observed in 4 patients from the ETGBD group. Overall survival did not differ significantly between the EUS-GBD group (mean 1070 days) and ETGBD group (mean 1470 days) (P = 0.292). Conclusion: The technical success rate for EUS-GBD using FCSEMS with plastic stent insertion was significantly higher with a shorter procedure time and resulted in a lower rate of recurrent AC.
Collapse
Affiliation(s)
- Kyouhei Nishiguchi
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Takeshi Ogura
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Atsushi Okuda
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Saori Ueno
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Nobu Nishioka
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Masanori Yamada
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Jun Matsuno
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Kazuya Ueshima
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Yoshitaro Yamamoto
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Kazuhide Higuchi
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| |
Collapse
|
8
|
Teoh AYB, Kongkam P, Bapaye A, Ratanachu T, Reknimitr R, Lakthakia S, Chan SM, Gadhikar HP, Korrapati SK, Lee YN, Medarapalem J, Ridtitid W, Moon JH. Use of a novel lumen apposing metallic stent for drainage of the bile duct and gallbladder: Long term outcomes of a prospective international trial. Dig Endosc 2021; 33:1139-1145. [PMID: 33284467 DOI: 10.1111/den.13911] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/27/2020] [Accepted: 12/02/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Long-term placement of lumen apposing metal stents (LAMS) with high lumen apposing force may result in adverse events. The aim of the current study was to assess the long-term efficacy and safety of a self-approximating LAMS with lower lumen apposing force for endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) and -gallbladder drainage (EUS-GBD). METHODS Five Asian institutions participated in this study. Consecutive patients suffering from obstructive jaundice with failed ERCP or acute cholecystitis that were at high risk for cholecystectomy were recruited. We evaluated the technical and clinical success rates, adverse events rates, types of interventions through the stent and the patency profile. RESULTS From June 2017 to Oct 2018, a total of 53 patients received EUS-CDS (26) and EUS-GBD (27). The technical and clinical success rates were similar between the two groups (88.5% vs 88.9%, P = 1 and 88.5% vs 88.9%, P = 1 respectively). The differences in 30-day mortality rates [2 (7.7%) vs 2 (7.7%), P = 1] and adverse events [3 (11.5%) vs 3 (11.5%), P = 1] did not reach significance. Regarding long-term outcomes, two patients in each group suffered from adverse events (P = 1). One patient in the EUS-GBD group who was on direct oral anticoagulant suffered from stent induced bleeding. CONCLUSION The self-approximating LAMS with lower lumen apposing force was effective and safe with a low risk of buried stent syndrome and bleeding in the longer term. The ClinicalTrials.gov Identifier was NCT03002051.
Collapse
Affiliation(s)
- Anthony Yuen Bun Teoh
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Pradermchai Kongkam
- Division of Gastroenterology, Department of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Amol Bapaye
- Department of Gastroenterology, Deenanath Mangeshkar Hospital, Pune, India
| | | | - Rungsun Reknimitr
- Division of Gastroenterology, Department of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Sundeep Lakthakia
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Shannon Melissa Chan
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Harshal P Gadhikar
- Department of Gastroenterology, Deenanath Mangeshkar Hospital, Pune, India
| | | | - Yun Nah Lee
- Department of Internal Medicine, SoonChunHyang University College of Medicine, Bucheon Hospital, Bucheon, Korea
| | - Jahangeer Medarapalem
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | | | - Jong Ho Moon
- Department of Internal Medicine, SoonChunHyang University College of Medicine, Bucheon Hospital, Bucheon, Korea
| |
Collapse
|
9
|
Maruta A, Iwashita T, Iwata K, Yoshida K, Uemura S, Mukai T, Yasuda I, Shimizu M. Permanent endoscopic gallbladder stenting versus removal of gallbladder drainage, long-term outcomes after management of acute cholecystitis in high-risk surgical patients for cholecystectomy: Multi-center retrospective cohort study. J Hepatobiliary Pancreat Sci 2021; 28:1138-1146. [PMID: 33844472 DOI: 10.1002/jhbp.967] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/23/2021] [Accepted: 04/04/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Endoscopic transpapillary gallbladder drainage (EGBD) has been reported as an effective gallbladder drainage treatment option for acute cholecystitis in high-risk surgical patients. However, the long-term outcomes such as cholecystitis' recurrence rate after placement of EGB stenting (EGBS) have not been well studied yet. AIMS The aim of the present study was to compare the long-term outcome of EGBS and removal of gallbladder drainage after percutaneous transhepatic gallbladder drainage (PTGBD) or endoscopic nasogallbladder drainage (ENGBD) for acute cholecystitis in high-risk surgical patients and clarify the usefulness of long-term placement of EGBS. METHODS We retrospectively studied 180 high-risk surgical patients with acute cholecystitis between January 2010 and December 2018. The patients were divided into two groups: EGBS group (long-term placement of EGBS) or Removal group (removal of drainage tube after PTGBD or ENGBD). Clinical outcomes, including long-term results, were compared between the groups. RESULTS The cumulative late adverse event (AE) rates were 5.0% and 22.1% in the EGBS and Removal group (P = .002), with a median follow-up period of 375 and 307 days in the two groups, respectively. The cumulative cholecystitis recurrence rate was 5.0% (2/40) in the EGBS group and 16% (21/131) in the Removal group (P = .024), respectively. In the multivariate analysis for late AE, only EGBS was an independent risk factor with a decreasing value. CONCLUSION The permanent EGBS in high-risk surgical patients with acute cholecystitis was considered effective in reducing the risk of late AE.
Collapse
Affiliation(s)
- Akinori Maruta
- Department of Gastroenterology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Takuji Iwashita
- First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
| | - Keisuke Iwata
- Department of Gastroenterology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Kensaku Yoshida
- Department of Gastroenterology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Shinya Uemura
- First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
| | - Tsuyoshi Mukai
- Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan
| | - Ichiro Yasuda
- Third Department of Internal Medicine, University of Toyama Hospital, Toyama, Japan
| | - Masahito Shimizu
- First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
| |
Collapse
|
10
|
Ogura T, Ueno S, Okuda A, Nishioka N, Higuchi K. One-step deployment for EUS-guided gallbladder drainage using a novel fully covered metal stent (with video). J Hepatobiliary Pancreat Sci 2020; 28:e4-e5. [PMID: 33283470 DOI: 10.1002/jhbp.876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/05/2020] [Accepted: 11/16/2020] [Indexed: 12/28/2022]
Abstract
Highlight A novel fully covered self-expandable metal stent has recently become available in Japan. Its stent delivery system measures only 7 Fr and its tip is tapered, allowing transluminal stenting under endoscopic ultrasound guidance without fistula dilation. Ogura and colleagues provide technical tips for endoscopic-ultrasound-guided gallbladder drainage using this novel stent.
Collapse
Affiliation(s)
- Takeshi Ogura
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Saori Ueno
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Atsushi Okuda
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Nobu Nishioka
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Kazuhide Higuchi
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| |
Collapse
|
11
|
Teoh AYB, Kitano M, Itoi T, Pérez-Miranda M, Ogura T, Chan SM, Serna-Higuera C, Omoto S, Torres-Yuste R, Tsuichiya T, Wong KT, Leung CH, Chiu PWY, Ng EKW, Lau JYW. Endosonography-guided gallbladder drainage versus percutaneous cholecystostomy in very high-risk surgical patients with acute cholecystitis: an international randomised multicentre controlled superiority trial (DRAC 1). Gut 2020; 69:1085-1091. [PMID: 32165407 DOI: 10.1136/gutjnl-2019-319996] [Citation(s) in RCA: 145] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 02/06/2020] [Accepted: 02/20/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The optimal management of acute cholecystitis in patients at very high risk for cholecystectomy is uncertain. The aim of the current study was to compare endoscopic ultrasound (EUS)-guided gallbladder drainage (EUS-GBD) to percutaneous cholecystostomy (PT-GBD) as a definitive treatment in these patients under a randomised controlled trial. DESIGN Consecutive patients suffering from acute calculous cholecystitis but were at very high-risk for cholecystectomy were recruited. The primary outcome was the 1-year adverse events rate. Secondary outcomes include technical and clinical success, 30-day adverse events, pain scores, unplanned readmissions, re-interventions and mortalities. RESULTS Between August 2014 to February 2018, 80 patients were recruited. EUS-GBD significantly reduced 1 year adverse events (10 (25.6%) vs 31 (77.5%), p<0.001), 30-day adverse events (5 (12.8%) vs 19 (47.5%), p=0.010), re-interventions after 30 days (1/39 (2.6%) vs 12/40 (30%), p=0.001), number of unplanned readmissions (6/39 (15.4%) vs 20/40 (50%), p=0.002) and recurrent cholecystitis (1/39 (2.6%) vs 8/40 (20%), p=0.029). Postprocedural pain scores and analgesic requirements were also less (p=0.034). The technical success (97.4% vs 100%, p=0.494), clinical success (92.3% vs 92.5%, p=1) and 30-day mortality (7.7% vs 10%, p=1) were statistically similar. The predictor to recurrent acute cholecystitis was the performance of PT-GBD (OR (95% CI)=5.63 (1.20-53.90), p=0.027). CONCLUSION EUS-GBD improved outcomes as compared to PT-GBD in those patients that not candidates for cholecystectomy. EUS-GBD should be the procedure of choice provided that the expertise is available after a multi-disciplinary meeting. Further studies are required to determine the long-term efficacy. TRIAL REGISTRATION NUMBER NCT02212717.
Collapse
Affiliation(s)
- Anthony Y B Teoh
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Masayuki Kitano
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Wakayama, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Manuel Pérez-Miranda
- Gastroenterology and Hepatology, University Hospital Rio Hortega, Valladolid, Spain
| | - Takeshi Ogura
- 2nd Department of Internal Medicine, Osaka Medical College, Takatuki, Japan
| | | | - Carlos Serna-Higuera
- Gastroenterology and Hepatology, University Hospital Rio Hortega, Valladolid, Spain
| | - Shunsuke Omoto
- Gastroenterology and Hepatology, Kinki University Faculty of Medicine, Osaka-sayama, Japan
| | - Raul Torres-Yuste
- Gastroenterology and Hepatology, University Hospital Rio Hortega, Valladolid, Spain
| | - Takayoshi Tsuichiya
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Ka Tak Wong
- Department of Diagnostic Radiology and Organ Imaging, The Chinese University of Hong Kong, Hong Kong, China
| | - Chi-Ho Leung
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Philip Wai Yan Chiu
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Enders Kwok Wai Ng
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - James Yun Wong Lau
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| |
Collapse
|
12
|
Abstract
EUS-guided gallbladder drainage (EUS-GBD) is gaining popularity as an option for drainage of the gallbladder in patients suffering from acute cholecystitis but at high risk for cholecystectomy. It allows internal drainage of the gallbladder and avoidance of the external tube as used in percutaneous cholecystostomy (PT-GBD). It may also provide additional benefits, including reduced re-admissions and re-interventions. In this chapter, we review the indications and outcomes of EUS-GBD. Furthermore, the follow-up management of patients that received EUS-GBD would be outlined.
Collapse
Affiliation(s)
- Anthony Yuen Bun Teoh
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| |
Collapse
|
13
|
Sowier S, Sowier A, Wiechowska-Kozłowska A, Białecki J, Pyda P. Initial experience with endoscopic ultrasound-guided gallbladder drainage. Wideochir Inne Tech Maloinwazyjne 2019; 14:195-202. [PMID: 31118983 DOI: 10.5114/wiitm.2018.79528] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 10/10/2018] [Indexed: 12/16/2022] Open
Abstract
Introduction Patients with acute cholecystitis who are unsuitable for cholecystectomy undergo conservative treatment or percutaneous transhepatic gallbladder drainage. As these two methods are not always successful, further treatment options are needed. One increasingly popular method is endoscopic ultrasound-guided gallbladder drainage (EUSGBD), whereby stents are placed so as to create a permanent fistula connecting the gallbladder to the stomach or the duodenal bulb, thus enabling drainage of its contents to the gastrointestinal tract. Aim To present our early experience with EUSGBD for the treatment of cholecystitis in patients who are not suitable for cholecystectomy. Material and methods The procedure was performed in 5 patients with acute cholecystitis. Two patients also had symptoms of biliary obstruction due to pancreatic head cancer. An ultrasound endoscope was used to create a fistula between the gallbladder and the stomach or between the gallbladder and the duodenal bulb, in which a self-expandable metallic stent (SEMS) was placed. Results All procedures were performed with no perioperative complications. In all patients, the clinical symptoms of cholecystitis subsided within 3-15 days. In those patients who also showed symptoms of biliary obstruction, these symptoms subsided within 3-6 days following the procedure. Conclusions The EUSGBD seems to be an effective and safe treatment for acute cholecystitis in patients unsuitable for cholecystectomy. It can also be used to treat jaundice caused by obstruction of the common bile duct, when no other methods can be used. The method is particularly promising in cases of concurrent acute cholecystitis and common bile duct obstruction.
Collapse
|
14
|
Minaga K, Yamashita Y, Ogura T, Takenaka M, Shimokawa Y, Hisa T, Itonaga M, Kato H, Nishikiori H, Okuda A, Matsumoto H, Uenoyama Y, Watanabe T, Chiba Y, Higuchi K, Kudo M, Kitano M. Clinical efficacy and safety of endoscopic ultrasound-guided gallbladder drainage replacement of percutaneous drainage: A multicenter retrospective study. Dig Endosc 2019; 31:180-187. [PMID: 30039611 DOI: 10.1111/den.13242] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 07/20/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Percutaneous transhepatic gallbladder drainage (PTGBD) is widely used for patients with acute cholecystitis. There are little data on the efficacy and safety of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) replacement of PTGBD in patients who cannot undergo cholecystectomy. METHODS This multicenter retrospective study in Japan reviewed records of patients who underwent EUS-GBD to replace PTGBD between January 2010 and December 2017. Outcomes evaluated included technical success, defined as successful stent placement between the gastrointestinal lumen and the gallbladder; clinical success, defined as subsequent removal of the percutaneous catheter; adverse events; and stent patency. RESULTS EUS-GBD was performed in 21 patients (14 women, mean age 77.5 ± 8.0 years) to replace PTGBD that had been instituted for acute cholecystitis (n = 19) or obstructive jaundice (n = 2). Technical success was achieved in 19 (90.5%). The median period from PTGBD placement to EUS-GBD was 11 days (range, 6-68 days). The mean procedure time was 19.5 ± 5.1 min. No early adverse events were observed. There were three late adverse events, distal stent migration in two cases and stent occlusion causing recurrent cholecystitis in one patient. Reintervention was required in two patients. The percutaneous catheter was removed after EUS-GBD in 17 patients at a median of 7 days (range, 2-20 days). The duration of stent patency was 139 days (range, 8-664 days). CONCLUSIONS Where ongoing gallbladder drainage is required, conversion from PTGBD to EUS-GBD is a feasible, effective, and safe technique for patients who cannot undergo cholecystectomy.
Collapse
Affiliation(s)
- Kosuke Minaga
- Therapeutic Endoscopic Ultrasound Group, Osaka, Japan.,Faculty of Medicine, Department of Gastroenterology and Hepatology, Kindai University, Osaka-Sayama, Japan
| | - Yukitaka Yamashita
- Therapeutic Endoscopic Ultrasound Group, Osaka, Japan.,Department of Gastroenterology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Takeshi Ogura
- Therapeutic Endoscopic Ultrasound Group, Osaka, Japan.,Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Japan
| | - Mamoru Takenaka
- Therapeutic Endoscopic Ultrasound Group, Osaka, Japan.,Faculty of Medicine, Department of Gastroenterology and Hepatology, Kindai University, Osaka-Sayama, Japan
| | - Yuzo Shimokawa
- Therapeutic Endoscopic Ultrasound Group, Osaka, Japan.,Department of Gastroenterology, Nakatsu Municipal Hospital, Nakatsu, Japan
| | - Takeshi Hisa
- Therapeutic Endoscopic Ultrasound Group, Osaka, Japan.,Department of Gastroenterology, Saku Central Hospital Advanced Care Center, Saku, Japan
| | - Masahiro Itonaga
- Therapeutic Endoscopic Ultrasound Group, Osaka, Japan.,Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Hironari Kato
- Therapeutic Endoscopic Ultrasound Group, Osaka, Japan.,Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hidefumi Nishikiori
- Therapeutic Endoscopic Ultrasound Group, Osaka, Japan.,Department of Gastroenterology, Oita San-ai Medical Center, Oita, Japan
| | - Atsushi Okuda
- Therapeutic Endoscopic Ultrasound Group, Osaka, Japan.,Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Japan
| | - Hisakazu Matsumoto
- Therapeutic Endoscopic Ultrasound Group, Osaka, Japan.,Department of Gastroenterology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Yoshito Uenoyama
- Therapeutic Endoscopic Ultrasound Group, Osaka, Japan.,Department of Gastroenterology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Tomohiro Watanabe
- Therapeutic Endoscopic Ultrasound Group, Osaka, Japan.,Faculty of Medicine, Department of Gastroenterology and Hepatology, Kindai University, Osaka-Sayama, Japan
| | - Yasutaka Chiba
- Therapeutic Endoscopic Ultrasound Group, Osaka, Japan.,Clinical Research Center, Kindai University Hospital, Osaka-Sayama, Japan
| | - Kazuhide Higuchi
- Therapeutic Endoscopic Ultrasound Group, Osaka, Japan.,Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Japan
| | - Masatoshi Kudo
- Therapeutic Endoscopic Ultrasound Group, Osaka, Japan.,Faculty of Medicine, Department of Gastroenterology and Hepatology, Kindai University, Osaka-Sayama, Japan
| | - Masayuki Kitano
- Therapeutic Endoscopic Ultrasound Group, Osaka, Japan.,Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| |
Collapse
|
15
|
Abstract
Recent literature has demonstrated effectiveness and safety of endoscopic ultrasound-guided gallbladder drainage, both as a primary intervention in patients with cholecystitis who are unfit for urgent surgical intervention and as a secondary intervention to internalize biliary drainage after initial placement of a percutaneous cholecystostomy catheter.
Collapse
Affiliation(s)
- Ryan Law
- Division of Gastroenterology, University of Michigan, 3912 Taubman Center, 1500 East Medical Center Drive, SPC 5362, Ann Arbor, MI 48109-5362, USA
| | - Todd H Baron
- Division of Gastroenterology and Hepatology, University of North Carolina, 130 Mason Farm Road, CB 7080, Chapel Hill, NC 27599-0001, USA.
| |
Collapse
|
16
|
Abstract
The gold standard for the management of acute cholecystitis is laparoscopic cholecystectomy. In patients that are not fit for surgery, percutaneous cholecystostomy is the standard treatment. However, the procedure is only a temporary measure for controlling gallbladder symptoms and it is frequently associated with morbidities. Recently, endoscopic options for management of acute cholecystitis have been developed. The approach avoids the need for a percutaneous drain and may allow endoscopic treatment of the gallstone. The aim of this article is to provide an overview on the current status of endoscopic management of acute cholecystitis.
Collapse
|