1
|
Chin NH, Chung CS, Chen KC, Wu JM. Endoscopic ultrasound-guided lumen-apposing metal stent for large gallstone removal in a symptomatic but surgically unfit patient. Asian J Surg 2023; 46:946-948. [PMID: 35973894 DOI: 10.1016/j.asjsur.2022.07.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 07/15/2022] [Indexed: 02/08/2023] Open
Affiliation(s)
- Ning-Hsuan Chin
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chen-Shuan Chung
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan; College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan; Taiwan Association for the Study of Small Intestinal Diseases (TASSID), Taiwan
| | - Kuan-Chih Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Jiann-Ming Wu
- Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
| |
Collapse
|
2
|
Zhang X, Yue P, Zhang J, Yang M, Chen J, Zhang B, Luo W, Wang M, Da Z, Lin Y, Zhou W, Zhang L, Zhu K, Ren Y, Yang L, Li S, Yuan J, Meng W, Leung JW, Li X. A novel machine learning model and a public online prediction platform for prediction of post-ERCP-cholecystitis (PEC). EClinicalMedicine 2022; 48:101431. [PMID: 35706483 PMCID: PMC9112124 DOI: 10.1016/j.eclinm.2022.101431] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/31/2022] [Accepted: 04/12/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND Endoscopic retrograde cholangiopancreatography (ERCP) is an established treatment for common bile duct (CBD) stones. Post- ERCP cholecystitis (PEC) is a known complication of such procedure and there are no effective models and clinical applicable tools for PEC prediction. METHODS A random forest (RF) machine learning model was developed to predict PEC. Eligible patients at The First Hospital of Lanzhou University in China with common bile duct (CBD) stones and gallbladders in-situ were enrolled from 2010 to 2019. Logistic regression analysis was used to compare the predictive discrimination and accuracy values based on receiver operation characteristics (ROC) curve and decision and clinical impact curve. The RF model was further validated by another 117 patients. This study was registered with ClinicalTrials.gov, NCT04234126. FINDINGS A total of 1117 patients were enrolled (90 PEC, 8.06%) to build the predictive model for PEC. The RF method identified white blood cell (WBC) count, endoscopic papillary balloon dilatation (EPBD), increase in WBC, residual CBD stones after ERCP, serum amylase levels, and mechanical lithotripsy as the top six predictive factors and has a sensitivity of 0.822, specificity of 0.853 and accuracy of 0.855, with the area under curve (AUC) value of 0.890. A separate logistic regression prediction model was built with sensitivity, specificity, and AUC of 0.811, 0.791, and 0.864, respectively. An additional 117 patients (11 PEC, 9.40%) were used to validate the RF model, with an AUC of 0.889 compared to an AUC of 0.884 with the logistic regression model. INTERPRETATION The results suggest that the proposed RF model based on the top six PEC risk factors could be a promising tool to predict the occurrence of PEC.
Collapse
Affiliation(s)
- Xu Zhang
- The First School of Clinical Medicne, Lanzhou University, Lanzhou,730030, Gansu, China
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, 730030,Gansu, China
| | - Ping Yue
- The First School of Clinical Medicne, Lanzhou University, Lanzhou,730030, Gansu, China
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, 730030,Gansu, China
- Gansu Province Key Laboratory of Biological Therapy and Regenerative Medicine Transformation, Lanzhou,730030, Gansu, China
| | - Jinduo Zhang
- The First School of Clinical Medicne, Lanzhou University, Lanzhou,730030, Gansu, China
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, 730030,Gansu, China
- Gansu Province Key Laboratory of Biological Therapy and Regenerative Medicine Transformation, Lanzhou,730030, Gansu, China
| | - Man Yang
- The First School of Clinical Medicne, Lanzhou University, Lanzhou,730030, Gansu, China
- Clinical Research Center, Big Data Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518107, Guangdong, China
| | - Jinhua Chen
- The First School of Clinical Medicne, Lanzhou University, Lanzhou,730030, Gansu, China
| | - Bowen Zhang
- State Key Laboratory of Applied Organic Chemistry, Lanzhou University, Lanzhou, 730030 , Gansu, China
| | - Wei Luo
- The First School of Clinical Medicne, Lanzhou University, Lanzhou,730030, Gansu, China
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, 730030,Gansu, China
| | - Mingyuan Wang
- The First School of Clinical Medicne, Lanzhou University, Lanzhou,730030, Gansu, China
- Department of Ultrasonography, The First Hospital of Lanzhou University, Lanzhou, 730030, Gansu, China
| | - Zijian Da
- The First School of Clinical Medicne, Lanzhou University, Lanzhou,730030, Gansu, China
| | - Yanyan Lin
- The First School of Clinical Medicne, Lanzhou University, Lanzhou,730030, Gansu, China
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, 730030,Gansu, China
- Gansu Province Key Laboratory of Biological Therapy and Regenerative Medicine Transformation, Lanzhou,730030, Gansu, China
| | - Wence Zhou
- The First School of Clinical Medicne, Lanzhou University, Lanzhou,730030, Gansu, China
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, 730030,Gansu, China
- Gansu Province Key Laboratory of Biological Therapy and Regenerative Medicine Transformation, Lanzhou,730030, Gansu, China
| | - Lei Zhang
- The First School of Clinical Medicne, Lanzhou University, Lanzhou,730030, Gansu, China
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, 730030,Gansu, China
- Gansu Province Key Laboratory of Biological Therapy and Regenerative Medicine Transformation, Lanzhou,730030, Gansu, China
| | - Kexiang Zhu
- The First School of Clinical Medicne, Lanzhou University, Lanzhou,730030, Gansu, China
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, 730030,Gansu, China
- Gansu Province Key Laboratory of Biological Therapy and Regenerative Medicine Transformation, Lanzhou,730030, Gansu, China
| | - Yu Ren
- The First School of Clinical Medicne, Lanzhou University, Lanzhou,730030, Gansu, China
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, 730030,Gansu, China
| | - Liping Yang
- The First School of Clinical Medicne, Lanzhou University, Lanzhou,730030, Gansu, China
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, 730030,Gansu, China
| | - Shuyan Li
- School of Medical Information and Engineering, Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
- Corresponding author.
| | - Jinqiu Yuan
- Clinical Research Center, Big Data Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518107, Guangdong, China
- Corresponding author.
| | - Wenbo Meng
- The First School of Clinical Medicne, Lanzhou University, Lanzhou,730030, Gansu, China
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, 730030,Gansu, China
- Gansu Province Key Laboratory of Biological Therapy and Regenerative Medicine Transformation, Lanzhou,730030, Gansu, China
- Corresponding author at: The First School of Clinical Medcine, Lanzhou University. Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, 730030,Gansu, China
| | - Joseph W. Leung
- Division of Gastroenterology, UC Davis Medical Center and Sacramento VA Medical Center, Sacramento, 95817, CA, USA
| | - Xun Li
- The First School of Clinical Medicne, Lanzhou University, Lanzhou,730030, Gansu, China
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, 730030,Gansu, China
- Gansu Province Key Laboratory of Biological Therapy and Regenerative Medicine Transformation, Lanzhou,730030, Gansu, China
| |
Collapse
|
3
|
Rajadurai A, Zorron Cheng Tao Pu L, Cameron R, Tagkalidis P, Holt B, Bassan M, Gupta S, Croagh D, Swan M, Saxena P, Efthymiou M, Vaughan R, Chandran S. Endoscopic ultrasound-guided gallbladder and bile duct drainage with lumen apposing metal stent: A large multicenter cohort (with videos). J Gastroenterol Hepatol 2022; 37:179-189. [PMID: 34562319 DOI: 10.1111/jgh.15688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/09/2021] [Accepted: 09/11/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM Cholecystectomy and endoscopic retrograde cholangiopancreatography are the gold standard for managing acute cholecystitis and malignant biliary obstruction, respectively. Recent advances in therapeutic endoscopic ultrasound (EUS) have provided alternatives for managing patients in whom these approaches fail, namely, EUS-guided gallbladder drainage (EUS-GB) and EUS-guided bile duct drainage (EUS-BD). We aimed to assess the technical and clinical success of these techniques in the largest multicenter cohort published to date. METHODS A retrospective, multicenter, observational study involving 17 centers across Australia and New Zealand was conducted. All patients who had EUS-GB or EUS-BD performed in a participating center using a lumen apposing metal stent between 2016 and 2020 were included. Primary outcome was technical success, defined as intra-procedural successful drainage. Secondary outcomes included clinical success and 30-day mortality. RESULTS One hundred and fifteen patients underwent EUS-GB (n = 49) or EUS-BD (n = 66). EUS-GB was technically successful in 47 (95.9%) while EUS-BD was successful in 60 (90.9%). All failed cases were due to maldeployment of the distal flange outside of the targeted lumen. Clinical success of EUS-GB was achieved in 39 (79.6%). No patients required subsequent cholecystectomy. Clinical success of EUS-BD was achieved in 52 (78.8 %). Thirty-day mortality was 14.3% for EUS-GB and 12.1% for EUS-BD. CONCLUSIONS EUS-guided gallbladder drainage and EUS-BD are promising alternatives for managing nonsurgical candidates with cholecystitis and malignant biliary obstruction following failed endoscopic retrograde pancreatography. Both techniques delivered high technical success with acceptable clinical success. Further research is needed to investigate the gap between technical and clinical success.
Collapse
Affiliation(s)
- Anton Rajadurai
- Department of Gastroenterology and Hepatology, Austin Health, Heidelberg, Victoria, Australia
| | | | - Rees Cameron
- Department of Gastroenterology and Hepatology, Austin Health, Heidelberg, Victoria, Australia
| | - Peter Tagkalidis
- Department of Gastroenterology and Hepatology, Austin Health, Heidelberg, Victoria, Australia
| | - Bronte Holt
- Department of Gastroenterology and Hepatology, Austin Health, Heidelberg, Victoria, Australia
| | - Milan Bassan
- Department of Gastroenterology and Hepatology, Austin Health, Heidelberg, Victoria, Australia
| | - Saurabh Gupta
- Department of Gastroenterology and Hepatology, Austin Health, Heidelberg, Victoria, Australia
| | - Daniel Croagh
- Department of Gastroenterology and Hepatology, Austin Health, Heidelberg, Victoria, Australia
| | - Michael Swan
- Department of Gastroenterology and Hepatology, Austin Health, Heidelberg, Victoria, Australia
| | - Payal Saxena
- Department of Gastroenterology and Hepatology, Austin Health, Heidelberg, Victoria, Australia
| | - Marios Efthymiou
- Department of Gastroenterology and Hepatology, Austin Health, Heidelberg, Victoria, Australia
| | - Rhys Vaughan
- Department of Gastroenterology and Hepatology, Austin Health, Heidelberg, Victoria, Australia
| | - Sujievvan Chandran
- Department of Gastroenterology and Hepatology, Austin Health, Heidelberg, Victoria, Australia
| | -
- Department of Gastroenterology and Hepatology, Austin Health, Heidelberg, Victoria, Australia
| |
Collapse
|
4
|
Bleeding From Buried Cholecystogastrostomy Lumen-Apposing Metal Stent: The Double Pigtail Catheter Rescue Treatment. ACG Case Rep J 2020; 7:e00368. [PMID: 32548196 PMCID: PMC7224718 DOI: 10.14309/crj.0000000000000368] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 02/12/2020] [Indexed: 11/21/2022] Open
Abstract
Lumen-apposing metal stents (LAMS) allow transmural drainage of the gallbladder for endoscopic management of acute cholecystitis in nonsurgical candidates. Delayed bleeding from cholecystogastrostomy or gallbladder after the LAMS placement has not been reported. There are no data for the replacement of LAMS with plastic stents to prevent recurrent delayed bleeding. We present a case to describe an alternative treatment approach for cholecystogastrostomy bleeding related to a buried LAMS.
Collapse
|
5
|
Farida JP, Church JT, Patel A, Young BA, Cho C, Law R. EUS-guided cholecystogastrostomy for acute cholecystitis in a patient with an omphalocele. VideoGIE 2020; 5:102-103. [PMID: 32154479 PMCID: PMC7058710 DOI: 10.1016/j.vgie.2019.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Jeremy P Farida
- Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA
| | - Joseph T Church
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Arpan Patel
- Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA
| | - Bree Ann Young
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Cliff Cho
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Ryan Law
- Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
6
|
Kostrzewa M, Zener R, Swanström LL, Shlomovitz E. An alternative percutaneous technique for gallbladder drainage using lumen-apposing metal stents. Surg Endosc 2019; 34:2512-2518. [PMID: 31392512 DOI: 10.1007/s00464-019-07060-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 08/01/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cholecystostomy is commonly performed in high-risk patients with acute cholecystitis. However, internal drainage may be more desirable in patients as it is associated with lower complication rates. This paper describes an image-guided, percutaneous technique for internal gallbladder drainage using a covered lumen-apposing metal stent (LAMS) and assesses its feasibility and safety in a porcine model. METHODS Procedures were performed on 30-kg pigs. Under ultrasound and fluoroscopic guidance, a percutaneous puncture was performed through-and-through the gallbladder into the stomach. A guidewire was placed and a 12Fr sheath was advanced through which a 10-mm LAMS was deployed. Its distal flange was deployed in the gastric lumen, and its proximal flange in the gallbladder. The cholecystoenteric anastomosis was examined by means of endoscopy, laparoscopy, and necropsy. RESULTS Technical success was 100% (7/7). Procedure times decreased with experience and improvements in technique (median: 22 min). Contrast injection demonstrated free flow through the stent with no leakage. Necropsy confirmed appropriate stent position with good apposition of gallbladder and stomach, and no intraprocedural complications were detected. CONCLUSIONS Image-guided, percutaneous, internal gallbladder drainage using a LAMS is safe and feasible in a porcine model. This technique may be an alternative to endoscopic ultrasound-guided stent placement and external cholecystostomy tube drainage.
Collapse
Affiliation(s)
- Michael Kostrzewa
- Division of Vascular and Interventional Radiology, Toronto General Hospital, University Health Network/University of Toronto, 585 University Avenue, Toronto, ON, M5G2N2, Canada. .,Institute of Image Guided Surgery (IHU), 1 Place de l'Hôpital, 67000, Strasbourg, France.
| | - Rebecca Zener
- Division of Vascular and Interventional Radiology, Toronto General Hospital, University Health Network/University of Toronto, 585 University Avenue, Toronto, ON, M5G2N2, Canada
| | - Lee L Swanström
- Institute of Image Guided Surgery (IHU), 1 Place de l'Hôpital, 67000, Strasbourg, France.,Gastrointestinal & Minimally Invasive Surgery, The Oregon Clinic, 4805 NE Glisan Street Suite 6N60, Portland, OR, 97213, USA
| | - Eran Shlomovitz
- Division of Vascular and Interventional Radiology, Toronto General Hospital, University Health Network/University of Toronto, 585 University Avenue, Toronto, ON, M5G2N2, Canada.,Institute of Image Guided Surgery (IHU), 1 Place de l'Hôpital, 67000, Strasbourg, France
| |
Collapse
|
7
|
Initial experience with endoscopic ultrasound-guided gallbladder drainage. Wideochir Inne Tech Maloinwazyjne 2019; 14:195-202. [PMID: 31118983 PMCID: PMC6528133 DOI: 10.5114/wiitm.2018.79528] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [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
|
8
|
Chang JI, Dong E, Kwok KK. Endoscopic ultrasound-guided transmural gallbladder drainage in malignant obstruction using a novel lumen-apposing stent: a case series (with video). Endosc Int Open 2019; 7:E655-E661. [PMID: 31058208 PMCID: PMC6497498 DOI: 10.1055/a-0826-4309] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 10/26/2018] [Indexed: 02/07/2023] Open
Abstract
Background and aims Current endoscopic methods of biliary decompression in malignant pancreatic neoplasms are often limited by anatomical and technical challenges. In this case series, we report our experience with endoscopic ultrasound (EUS)-guided placement of an electrocautery-enhanced, lumen-apposing self-expandable metallic stent (LAMS) via transmural gallbladder drainage. Methods This is a retrospective case series of nine patients (five male, mean age 63.1 years) who underwent EUS-guided LAMS placement for malignant, obstructive jaundice in the pancreatic head. All nine cases were performed by an experienced interventional endoscopist at a single, tertiary medical center. We review the technical and clinical success rates as well as the incidence of procedural adverse events across the nine patients. Results LAMS placement was technically successful in all cases and there were no procedural adverse events. Seven of nine (77.78 %) patients showed clinical and laboratory improvement immediately following the procedure. One case required re-intervention with interventional radiology guided biliary drain placement. The mean fluoroscopy time was 1.02 minutes. Conclusions EUS-guided LAMS placement for transmural gallbladder drainage in malignant obstruction appears to be a safe and effective technique, allowing patients to proceed to surgery, chemotherapy, or hospice care.
Collapse
Affiliation(s)
- Jonathan I. Chang
- Division of Gastroenterology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Elizabeth Dong
- Division of Gastroenterology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Karl K. Kwok
- Division of Gastroenterology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA,Corresponding author Karl K. Kwok, MD 1526 North Edgemont Street7th FloorLos AngelesCA 90027USA+1-323-783-7056
| |
Collapse
|
9
|
Endoscopic ultrasound-guided gallbladder drainage for acute cholecystitis with a lumen-apposing metal stent: a systematic review of case series. Eur J Gastroenterol Hepatol 2018; 30:695-698. [PMID: 29578866 DOI: 10.1097/meg.0000000000001112] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Management of patients with acute cholecystitis unfit for surgery is challenging. Recently, endoscopic ultrasound (EUS)-guided gallbladder drainage with a lumen-apposing metal stent (LAMS) has been introduced for these patients. We performed a systematic review and pooled-data analysis in this field. A comprehensive review of case series on gallbladder drainage with EUS-guided LAMS placement was performed. Only case series with at least five patients were considered. The rates of technical success, clinical success, and adverse events were computed. Overall, nine case series with a total of 226 patients were identified. The stent was positioned successfully in 215 cases [95.1%, 95% confidence interval (CI)=92.3-98]. Clinical success was achieved in 207 patients, corresponding to a 91.6% (95% CI=88-95.2) rate at intention-to-treat analysis and 96.3% (95% CI=93.7-99) at per-protocol analysis. A total of 24 (10.6%) adverse events occurred, including 11 (4.9%) cases during the procedure, and 13 (5.7%) observed at follow-up (median=6 months; range: 2-12 months). A surgical approach was required in only 25% of patients with a major adverse event. No case of procedure-related death was reported. EUS-guided LAMS placement for gallbladder drainage in patients with acute cholecystitis not suitable for surgery is highly successful and acceptably safe.
Collapse
|
10
|
Zener R, Swanström LL, Shlomovitz E. Anatomic Feasibility of Percutaneous Cholecystoenteric Fistula Creation and Stent Insertion in Acute Cholecystitis. Surg Innov 2018; 25:339-345. [PMID: 29909734 DOI: 10.1177/1553350618780769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To assess the prevalence of patients whose anatomy would be potentially amenable to percutaneous cholecystoenteric lumen-apposing metallic stents (LAMS) insertion from a population of acute cholecystitis patients. METHODS Contrast-enhanced abdominal computed tomography images in 100 consecutive adult patients with acute cholecystitis were reviewed retrospectively. Feasibility of LAMS placement percutaneously or with endoscopic ultrasound guidance was defined as the presence of a straight and unobstructed trajectory from the skin to the gallbladder, and between the gallbladder and the gastric antrum, or the proximal duodenum, measuring ≤2 cm, respectively. RESULTS The gallbladder was within 2 cm of the gastric antrum or proximal duodenum without intervening structures in 95 of 100 patients (95%). Percutaneous LAMS appeared anatomically feasible in 90 of 100 patients (90%). Mean ± SD shortest inner-inner wall distance between the gallbladder and the adjacent proximal gastrointestinal tract was 1.20 ± 0.43 cm. The closest location for percutaneous LAMS was between the gallbladder and duodenum in 87 of the feasible cases (97%). The percutaneous approach was transhepatic in 89.5%, and extrahepatic in 10.5%. Endoscopic ultrasound-guided LAMS appeared feasible in 95 of 100 patients, including 5 of the 10 percutaneously unfeasible cases. The other 5 patients appeared unfeasible due to colonic interposition or other intervening structures. CONCLUSIONS LAMS appeared anatomically feasible percutaneously in 90% of acute cholecystitis patients. The shortest and most direct path for percutaneous LAMS was transhepatic and cholecystoduodenal. Percutaneously placed LAMS may be an attractive alternative to percutaneous cholecystostomy.
Collapse
Affiliation(s)
- Rebecca Zener
- 1 University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | | | - Eran Shlomovitz
- 1 University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| |
Collapse
|
11
|
Manta R, Zulli C, Zullo A, Forti E, Tringali A, Dioscoridi L, Zito F, Bertani H, Conigliaro R, Mutignani M. Endoscopic ultrasound-guided gallbladder drainage for acute cholecystitis with a silicone-covered nitinol short bilaterally flared stent: a case series. Endosc Int Open 2017; 5:E1111-E1115. [PMID: 29124119 PMCID: PMC5677460 DOI: 10.1055/s-0043-118659] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 07/24/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND STUDY AIM Gallbladder drainage in patients with cholecystitis who are unsuitable for surgery may be performed by endoscopic ultrasound (EUS)-guided placement of specifically designed fully covered metal stents. We describe the first case series of patients treated with a silicone-covered nitinol stent with bilateral anchor flanges. PATIENTS AND METHODS Data from consecutive patients with acute cholecystitis who were deemed unsuitable candidates for surgery were collected. The stent placement procedure was performed in two tertiary endoscopy centers by four experienced endoscopists. Technical and clinical success rates, as well as adverse events and clinical outcome at follow-up, were assessed. RESULTS EUS-guided drainage for cholecystitis was performed in 16 patients (mean age 84 years; nine males). Technical and clinical success rates were 100 % (16/16) and 94 % (15/16), respectively; an early failure due to stone impaction occurred in the remaining case and required placement of a new stent. Symptom relief occurred in 11/15 cases (73 %) within 1 day, and within 2 days in the remaining 4 patients. Bleeding occurred in two patients (13 %): in one patient intraprocedural bleeding was successfully stopped during endoscopy; and delayed bleeding occurred in one patient requiring arterial embolization for catastrophic bleeding (patient died 10 days later). No cases of cholecystitis recurrence or biliary obstruction were observed during a median follow-up of 112 days (range 49 - 180 days). CONCLUSIONS Our data showed that EUS-guided gallbladder drainage with a specially designed stent is feasible and successful in patients with acute cholecystitis who are unfit for surgery.
Collapse
Affiliation(s)
- Raffaele Manta
- Gastroenterology Unit, Nuovo Ospedale Civile Sant’ Agostino-Estense, Baggiovara-Modena, Italy,Corresponding author Raffaele Manta, MD Gastroenterology UnitNuovo Ospedale Civile Sant’ Agostino-EstenseViale Giardini AuslBaggiovaraModenaItaly+39-059-659235
| | - Claudio Zulli
- Endoscopy Unit, AOUI San Giovanni di Dio e Ruggi d’Aragona, G. Fucito Center, Mercato San Severino (SA), Italy
| | - Angelo Zullo
- Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Edoardo Forti
- Surgical Endoscopy Unit, ASST Niguarda Hospital, Milan, Italy
| | | | | | - Francesco Zito
- Gastroenterology Unit, Nuovo Ospedale Civile Sant’ Agostino-Estense, Baggiovara-Modena, Italy
| | - Helga Bertani
- Gastroenterology Unit, Nuovo Ospedale Civile Sant’ Agostino-Estense, Baggiovara-Modena, Italy
| | - Rita Conigliaro
- Gastroenterology Unit, Nuovo Ospedale Civile Sant’ Agostino-Estense, Baggiovara-Modena, Italy
| | | |
Collapse
|
12
|
Venkatachalapathy S, Nayar MK. Therapeutic endoscopic ultrasound. Frontline Gastroenterol 2017; 8:119-123. [PMID: 28261439 PMCID: PMC5318651 DOI: 10.1136/flgastro-2016-100774] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 12/13/2016] [Accepted: 12/15/2016] [Indexed: 02/07/2023] Open
Abstract
Endoscopic ultrasound (EUS) is now firmly established as one of the essential tools for diagnosis in most gastrointestinal MDTs across the UK. However, the ability to provide therapy with EUS has resulted in a significant impact on the management of the patients. These include drainage of peripancreatic collections, EUS-guided endoscopic retrograde cholangiopancreatogram, EUS-guided coeliac plexus blocks, etc. The rapid development of this area in endoscopy is a combination of newer tools and increasing expertise by endosonographers to push the boundaries of intervention with EUS. However, the indications are limited and we are at the start of the learning curve for these high-risk procedures. These therapies should, therefore, be confined to centres with a robust multidisciplinary team, including interventional endoscopists, radiologists and surgeons.
Collapse
Affiliation(s)
- Suresh Venkatachalapathy
- Department of Gastroenterology and Hepatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Manu K Nayar
- HPB Unit, Freeman Hospital, Newcastle Upon Tyne, UK
| |
Collapse
|
13
|
Affiliation(s)
- Richard A. Kozarek
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, United States
| |
Collapse
|
14
|
Zhang K, Guo J, Sun S. Retrievable puncture anchor-assisted gallbladder drainage: Throwing the gallbladder a lifeline. Endosc Ultrasound 2017; 6:355-358. [PMID: 29251268 PMCID: PMC5752756 DOI: 10.4103/eus.eus_101_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Kai Zhang
- Endoscopic Center, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Jintao Guo
- Endoscopic Center, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Siyu Sun
- Endoscopic Center, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| |
Collapse
|