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Combined EUS-guided gallbladder drainage with rendezvous ERCP for treatment of concomitant cholecystitis, cholelithiasis, and choledocholithiasis.

ABSTRACT: Video 1EUS-guided gallbladder drainage followed by rendezvous ERCP.

SUBMITTER: Lu R

PROVIDER: S-EPMC9263873 | biostudies-literature | 2022 Jul

REPOSITORIES: biostudies-literature

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Combined EUS-guided gallbladder drainage with rendezvous ERCP for treatment of concomitant cholecystitis, cholelithiasis, and choledocholithiasis.

Lu Ray R Luthra Anjuli A Han Samuel S

VideoGIE : an official video journal of the American Society for Gastrointestinal Endoscopy 20220412 7

Video 1EUS-guided gallbladder drainage followed by rendezvous ERCP. ...[more]

PMID: 35815163

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Single-session EUS-guided gastroenterostomy and EUS-guided gallbladder drainage in a patient with concomitant gastric outlet obstruction and acalculous cholecystitis.

Project description:Video 1Video presentation of a single session EUS-guided cholecystoduodenostomy and gastrojejunostomy.

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EUS-guided gallbladder drainage vs dual stent transpapillary gallbladder drainage for management of acute cholecystitis.

Project description:Background and study aimsCholecystectomy (CCY) is the standard treatment for acute cholecystitis. For non-surgical patients, percutaneous cholecystostomy tube (PT-GBD) is recommended but is associated with high readmission rates and poor quality of life. Endoscopic gallbladder decompression techniques, including endoscopic transpapillary gallbladder drainage (ET-GBD) and endoscopic ultrasound-guided gallbladder drainage (EUS-GBD), are alternatives. Studies comparing ET-GBD and EUS-GBD have shown EUS-GBD to have superior outcomes. However, these studies assessed ET-GBD mostly via single transcystic stent placement (SSET-GBD). This study aimed to compare outcomes of dual transcystic stents (DSET-GBD) and EUS-GBD in non-surgical candidates with acute cholecystitis.Patients and methodsA multicenter analysis was conducted on patients who underwent ET-GBD or EUS-GBD between January 2019 and January 2023. Data were extracted from electronic medical records and outcomes including technical success, success, adverse events (AEs), and recurrence rates of cholecystitis were measured.ResultsOf 129 procedures (56 EUS-GBD; 73 ET-GBD), technical success was achieved in 87.5% of EUS-GBD and 86.3% of ET-GBD attempts. Immediate clinical success was achieved in 98.1% for EUS-GBD and 100% for DSET-GBD. AE rates were similar between the groups. Recurrent cholecystitis rates were 5.3% for EUS-GBD and 8.2% for DSET-GBD ( P = 0.692).ConclusionsThis study demonstrates that DSET-GBD has similarly low rates of recurrent acute cholecystitis compared with EUS-GBD. DSET-GBD should be considered as an alternative management strategy for management of acute cholecystitis in patients who are unable to undergo CCY.

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EUS-guided rendezvous with a steerable access needle in choledocholithiasis.

Project description: Not available

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Recurrent cholecystitis with complete internal migration of a pigtail stent treated with EUS-guided gallbladder drainage

Project description:Video Video 1 Complete internal migration of a cholecystoduodenal pigtail stent leading to recurrent cholecystitis, which was then rescued with new EUS-guided gallbladder drainage.

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Project description:Video 1Full metal jacket: salvage of EUS-guided gallbladder drainage.

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EUS-guided gallbladder drainage in high-risk surgical patients with acute cholecystitis-procedure outcomes and evaluation of mortality predictors.

Project description:BackgroundRecent evidences suggest that gallbladder drainage is the treatment of choice in elderly or high-risk surgical patients with acute cholecystitis (AC). Despite better outcomes compared to other approaches, endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is burdened by high mortality. The aim of the study was to evaluate predictive factors for mortality in high-risk surgical patients who underwent EUS-GBD for AC.MethodsA retrospective analysis of a prospectively maintained database was performed. Electrocautery-enhanced lumen-apposing metal stents were used; all recorded variables were evaluated as potential predictive factors for mortality.ResultsThirty-four patients underwent EUS for suspected AC and 25 (44% male, age 78) were finally included. Technical, clinical success rate and adverse events rate were 92%, 88%, and 16%, respectively. 30-day and 1-year mortality were 12% and 32%. On univariate analysis, age-adjusted Charlson Comorbidity Index (CCI) (OR 20.8[4-68.2]), acute kidney injury (AKI) (OR 21.4[2.6-52.1]) and clinical success (OR 8.9[1.2-11.6]) were related to 30-day mortality. On multivariate analysis, CCI and AKI were independently related to long-term mortality. Kaplan-Meier curves showed an increased long-term mortality in patients with CCI > 6 (hazard ratio 7.6[1.7-34.6]) and AKI (hazard ratio 11.3[1.4-91.5]).ConclusionsSevere comorbidities and AKI were independent predictive factors confirming of long-term mortality after EUS-GBD. Outcomes of EUS-GBD appear more influenced by patients' conditions rather than by procedure success.

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Project description: Not available

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Project description:Background: Percutaneous transhepatic gallbladder drainage (PT-GBD) has been the treatment of choice for acute cholecystitis patients who are not suitable for surgery. The effectiveness of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) as an alternative to PT-GBD is not clear. In this meta-analysis, we have compared their efficacy and adverse events. Methods: We adhered to the PRISMA statement to conduct this meta-analysis. Online databases were searched for studies that compared EUS-GBD and PT-GBD for acute cholecystitis. The primary outcomes of interest were technical success, clinical success, and adverse events. The pooled odds ratio (OR) with a 95% confidence interval (CI) was calculated using the random-effects model. Results: A total of 396 articles were screened, and 11 eligible studies were identified. There were 1136 patients, of which 57.5% were male, 477 (mean age 73.33 ± 11.28 years) underwent EUS-GBD, and 698 (mean age 73.77 ± 8.7 years) underwent PT-GBD. EUS-GBD had significantly better technical success (OR 0.40; 95% CI 0.17-0.94; p = 0.04), fewer adverse events (OR 0.35; 95% CI 0.21-0.61; p = 0.00), and lower reintervention rates (OR 0.18; 95% CI 0.05-0.57; p = 0.00) than PT-GBD. No difference in clinical success (OR 1.34; 95% CI 0.65-2.79; p = 0.42), readmission rate (OR 0.34; 95% CI 0.08-1.54; p = 0.16), or mortality rate (OR 0.73; 95% CI 0.30-1.80; p = 0.50) was noted. There was low heterogeneity (I2 = 0) among the studies. Egger's test showed no significant publication bias (p = 0.595). Conclusion: EUS-GBD can be a safe and effective alternative to PT-GBD for treating acute cholecystitis in non-surgical patients and has fewer adverse events and a lower reintervention rate than PT-GBD.

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