Kosuke Minaga1,2, Yukitaka Yamashita1,3, Takeshi Ogura1,4, Mamoru Takenaka1,2, Yuzo Shimokawa1,5, Takeshi Hisa1,6, Masahiro Itonaga1,7, Hironari Kato1,8, Hidefumi Nishikiori1,9, Atsushi Okuda1,4, Hisakazu Matsumoto1,3, Yoshito Uenoyama1,3, Tomohiro Watanabe1,2, Yasutaka Chiba1,10, Kazuhide Higuchi1,4, Masatoshi Kudo1,2, Masayuki Kitano1,7. 1. Therapeutic Endoscopic Ultrasound Group, Osaka, Japan. 2. Faculty of Medicine, Department of Gastroenterology and Hepatology, Kindai University, Osaka-Sayama, Japan. 3. Department of Gastroenterology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan. 4. Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Japan. 5. Department of Gastroenterology, Nakatsu Municipal Hospital, Nakatsu, Japan. 6. Department of Gastroenterology, Saku Central Hospital Advanced Care Center, Saku, Japan. 7. Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan. 8. Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. 9. Department of Gastroenterology, Oita San-ai Medical Center, Oita, Japan. 10. Clinical Research Center, Kindai University Hospital, Osaka-Sayama, Japan.
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.
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.