Markus Dollhopf1, Alberto Larghi2, Uwe Will3, Mihai Rimbaş4, Andrea Anderloni5, Andres Sanchez-Yague6, Anthony Yuen Bun Teoh7, Rastislav Kunda8. 1. Department of Gastroenterology, Klinikum Neuperlach, München, Germany. 2. Digestive Endoscopy Unit, Catholic University, Rome, Italy. 3. Department of Gastroenterology, Municipal Hospital, Gera, Germany. 4. Digestive Endoscopy Unit, Catholic University, Rome, Italy; Gastroenterology and Internal Medicine Departments, Colentina Clinical Hospital, Carol Davila University of Medicine, Bucharest, Romania. 5. Department of Gastroenterology, Digestive Endoscopy Unit, Humanitas Research Hospital, Rozzano, Italy. 6. Endoscopy Unit, Hospital Costa del Sol, Marbella, Spain. 7. Department of Surgery, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China. 8. Department of Surgical Gastroenterology, L Aarhus University Hospital, Aarhus, Denmark.
Abstract
BACKGROUND AND AIMS: In high-risk surgical patients, the treatment of choice of acute cholecystitis is percutaneous transhepatic gallbladder drainage (PTGBD). Recently, a novel endoscopic device containing a lumen-apposing metal stent with an electrocautery (ECE-LAMS) on the tip has been developed. METHODS: High-risk surgical patients with acute cholecystitis who underwent EUS-guided gallbladder drainage (EUS-GBD) with the novel device were retrospectively retrieved from 7 tertiary care referral centers. Main endpoints were technical and clinical success rates, rate of procedural adverse events, and short- and long-term adverse events. RESULTS: Seventy-five patients (mean age, 75 ± 11 years; 36 men) underwent EUS-GBD. The procedure was technically and clinically successful in 98.7% and 95.9% of cases, respectively. Three patients without resolution of cholecystitis died, and 2 patients had procedure-related adverse events: 1 perforation requiring surgery and 1 major bleeding resolved conservatively. The mean follow-up for the entire cohort was 201 ± 226 days. Seven patients (9.6%) died within the first 30 days; 50 patients (71.4%) were alive at the last date of follow-up. Short- and long-term adverse events occurred in 6 patients: 3 had recurrent cholecystitis, 2 had migration of the stent, and 1 developed Bouveret syndrome, all managed nonsurgically. Overall, 8 adverse events (10.7%) occurred in the entire cohort of patients. CONCLUSIONS: The novel ECE-LAMS for high-risk surgical patients with acute cholecystitis is safe, with a high technical and clinical success rate. Future multicenter studies comparing EUS-GBD versus PTGBD are warranted to determine which procedure is safer and clinically more effective for patients with high surgical risk acute cholecystitis.
BACKGROUND AND AIMS: In high-risk surgical patients, the treatment of choice of acute cholecystitis is percutaneous transhepatic gallbladder drainage (PTGBD). Recently, a novel endoscopic device containing a lumen-apposing metal stent with an electrocautery (ECE-LAMS) on the tip has been developed. METHODS: High-risk surgical patients with acute cholecystitis who underwent EUS-guided gallbladder drainage (EUS-GBD) with the novel device were retrospectively retrieved from 7 tertiary care referral centers. Main endpoints were technical and clinical success rates, rate of procedural adverse events, and short- and long-term adverse events. RESULTS: Seventy-five patients (mean age, 75 ± 11 years; 36 men) underwent EUS-GBD. The procedure was technically and clinically successful in 98.7% and 95.9% of cases, respectively. Three patients without resolution of cholecystitis died, and 2 patients had procedure-related adverse events: 1 perforation requiring surgery and 1 major bleeding resolved conservatively. The mean follow-up for the entire cohort was 201 ± 226 days. Seven patients (9.6%) died within the first 30 days; 50 patients (71.4%) were alive at the last date of follow-up. Short- and long-term adverse events occurred in 6 patients: 3 had recurrent cholecystitis, 2 had migration of the stent, and 1 developed Bouveret syndrome, all managed nonsurgically. Overall, 8 adverse events (10.7%) occurred in the entire cohort of patients. CONCLUSIONS: The novel ECE-LAMS for high-risk surgical patients with acute cholecystitis is safe, with a high technical and clinical success rate. Future multicenter studies comparing EUS-GBD versus PTGBD are warranted to determine which procedure is safer and clinically more effective for patients with high surgical risk acute cholecystitis.
Authors: Andrea Anderloni; Carlo Fabbri; Jose Nieto; Will Uwe; Markus Dollhopf; José Ramón Aparicio; Manuel Perez-Miranda; Ilaria Tarantino; Alexander Arlt; Frank Vleggaar; Geoffrey Vanbiervliet; Jochen Hampe; Michel Kahaleh; Juan J Vila; Barham K Abu Dayyeh; Andrew C Storm; Alessandro Fugazza; Cecilia Binda; Antoine Charachon; Sergio Sevilla-Ribota; Amy Tyberg; Moran Robert; Sachin Wani; Alessandro Repici; Amrita Sethi; Mouen A Khashab; Rastislav Kunda Journal: Surg Endosc Date: 2020-04-22 Impact factor: 4.584
Authors: Thomas R McCarty; Kelly E Hathorn; Ahmad Najdat Bazarbashi; Kunal Jajoo; Marvin Ryou; Christopher C Thompson Journal: Surg Endosc Date: 2021-07-06 Impact factor: 4.584