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Tozuka Y, Sugimori K, Miwa H, Kaneko T, Ueno M, Furuse J, Maeda S. Endoscopic ultrasound-guided gallbladder drainage using a forward-viewing echoendoscope after Billroth II gastrectomy. Endoscopy 2024; 56:E238-E239. [PMID: 38458243 PMCID: PMC10923632 DOI: 10.1055/a-2271-4124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
Affiliation(s)
- Yuichiro Tozuka
- Department of Gastroenterology, Kanagawa Cancer Center, Yokohama, Japan
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Kazuya Sugimori
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Haruo Miwa
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Takashi Kaneko
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Makoto Ueno
- Department of Gastroenterology, Kanagawa Cancer Center, Yokohama, Japan
| | - Junji Furuse
- Department of Gastroenterology, Kanagawa Cancer Center, Yokohama, Japan
| | - Shin Maeda
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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2
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Coccolini F, Cucinotta E, Mingoli A, Zago M, Altieri G, Biloslavo A, Caronna R, Cengeli I, Cicuttin E, Cirocchi R, Cobuccio L, Costa G, Cozza V, Cremonini C, Del Vecchio G, Dinatale G, Fico V, Galatioto C, Kuriara H, Lacavalla D, La Greca A, Larghi A, Mariani D, Mirco P, Occhionorelli S, Parini D, Polistina F, Rimbas M, Sapienza P, Tartaglia D, Tropeano G, Venezia P, Venezia DF, Zaghi C, Chiarugi M. Acute cholecystitis management in high-risk, critically ill, and unfit-for-surgery patients: the Italian Society of Emergency Surgery and Trauma (SICUT) guidelines. Updates Surg 2024; 76:331-343. [PMID: 38153659 DOI: 10.1007/s13304-023-01729-8] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 12/05/2023] [Indexed: 12/29/2023]
Abstract
Dealing with acute cholecystitis in high-risk, critically ill, and unfit-for-surgery patients is frequent during daily practice and requires complex management. Several procedures exist to postpone and/or prevent surgical intervention in those patients who temporarily or definitively cannot undergo surgery. After a systematic review of the literature, an expert panel from the Italian Society of Emergency Surgery and Trauma (SICUT) discussed the different issues and statements in subsequent rounds. The final version of the statements was discussed during the annual meeting in Rome (September 2022). The present paper presents the definitive conclusions of the discussion. Fifteen statements based on the literature evidence were provided. The statements gave precise indications regarding the decisional process and the management of patients who cannot temporarily or definitively undergo cholecystectomy for acute cholecystitis. Acute cholecystitis management in high-risk, critically ill, and unfit-for-surgery patients should be multidisciplinary. The different gallbladder drainage methods must be tailored according to each patient and based on the expertise of the hospital. Percutaneous gallbladder drainage is recommended as the first choice as a bridge to surgery or in severely physiologically deranged patients. Endoscopic gallbladder drainage (cholecystoduodenostomy and cholecystogastrostomy) is suggested as a second-line alternative especially as a definitive procedure for those patients not amenable to surgical management. Trans-papillary gallbladder drainage is the last option to be reserved only to those unfit for other techniques. Delayed laparoscopic cholecystectomy in patients with percutaneous gallbladder drainage is suggested in all those patients recovering from the conditions that previously discouraged surgical intervention after at least 6 weeks from the gallbladder drainage.
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Affiliation(s)
- Federico Coccolini
- General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa University, Via Paradisia 1, Pisa, Italy.
| | - Eugenio Cucinotta
- General Surgery Department, Messina University Hospital, Messina, Italy
| | - Andrea Mingoli
- Emergency Department, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Mauro Zago
- General Surgery Department, Lecco Hospital, Lecco, Italy
| | - Gaia Altieri
- Department of Trauma and Emergency Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alan Biloslavo
- General Surgery Department, Trieste University Hospital, Trieste, Italy
| | - Roberto Caronna
- General Surgery Department, Messina University Hospital, Messina, Italy
| | - Ismail Cengeli
- General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa University, Via Paradisia 1, Pisa, Italy
| | - Enrico Cicuttin
- General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa University, Via Paradisia 1, Pisa, Italy
| | - Roberto Cirocchi
- General Surgery Department, Perugia University Hospital, Perugia, Italy
| | - Luigi Cobuccio
- General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa University, Via Paradisia 1, Pisa, Italy
| | - Gianluca Costa
- General Surgery Department, Campus Biomedico University Hospital, Rome, Italy
| | - Valerio Cozza
- Department of Trauma and Emergency Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Camilla Cremonini
- General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa University, Via Paradisia 1, Pisa, Italy
| | | | | | - Valeria Fico
- Department of Trauma and Emergency Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Hayato Kuriara
- Emergency Surgery Department, Policlinico Hospital, Milan, Italy
| | - Domenico Lacavalla
- Emergency Surgery Department, Ferrara University Hospital, Ferrara, Italy
| | - Antonio La Greca
- Department of Trauma and Emergency Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alberto Larghi
- Department of Trauma and Emergency Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Diego Mariani
- General Surgery Department, Legnano Hospital, Legnano, Italy
| | - Paolo Mirco
- Department of Trauma and Emergency Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Dario Parini
- General Surgery Department, Rovigo Hospital, Rovigo, Italy
| | | | - Mihai Rimbas
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
- Department of Internal Medicine, Carol Davila University of Medicine, Bucharest, Romania
| | - Paolo Sapienza
- Emergency Department, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Dario Tartaglia
- General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa University, Via Paradisia 1, Pisa, Italy
| | - Giuseppe Tropeano
- Department of Trauma and Emergency Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Piero Venezia
- General Surgery Department, Bari University Hospital, Bari, Italy
| | | | - Claudia Zaghi
- General Surgery Department, Vicenza Hospital, Vicenza, Italy
| | - Massimo Chiarugi
- General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa University, Via Paradisia 1, Pisa, Italy
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Manudhane AP, Leupold MD, Shah HW, Shah R, Han SY, Lee PJ, Burlen JJ, Papachristou GI, Krishna SG. A Review on Endoscopic Management of Acute Cholecystitis: Endoscopic Ultrasound-Guided Gallbladder Drainage and Endoscopic Transpapillary Gallbladder Drainage. Medicina (Kaunas) 2024; 60:212. [PMID: 38399500 PMCID: PMC10890498 DOI: 10.3390/medicina60020212] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 01/20/2024] [Accepted: 01/21/2024] [Indexed: 02/25/2024]
Abstract
A percutaneous cholecystostomy tube (PCT) is the conventionally favored nonoperative intervention for treating acute cholecystitis. However, PCT is beset by high adverse event rates, need for scheduled reintervention, and inadvertent dislodgement, as well as patient dissatisfaction with a percutaneous drain. Recent advances in endoscopic therapy involve the implementation of endoscopic transpapillary drainage (ETP-GBD) and endoscopic ultrasound-guided gallbladder drainage (EUS-GBD), which are increasingly preferred over PCT due to their favorable technical and clinical success combined with lower complication rates. In this article, we provide a comprehensive review of the literature on EUS-GBD and ETP-GBD, delineating instances when clinicians should opt for endoscopic management and highlighting potential risks associated with each approach.
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Affiliation(s)
- Albert P. Manudhane
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Suite 262, Columbus, OH 43210, USA; (A.P.M.)
| | - Matthew D. Leupold
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Hamza W. Shah
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Suite 262, Columbus, OH 43210, USA; (A.P.M.)
| | - Raj Shah
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Suite 262, Columbus, OH 43210, USA; (A.P.M.)
| | - Samuel Y. Han
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Suite 262, Columbus, OH 43210, USA; (A.P.M.)
| | - Peter J. Lee
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Suite 262, Columbus, OH 43210, USA; (A.P.M.)
| | - Jordan J. Burlen
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Suite 262, Columbus, OH 43210, USA; (A.P.M.)
| | - Georgios I. Papachristou
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Suite 262, Columbus, OH 43210, USA; (A.P.M.)
| | - Somashekar G. Krishna
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Suite 262, Columbus, OH 43210, USA; (A.P.M.)
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Fugazza A, Khalaf K, Pawlak KM, Spadaccini M, Colombo M, Andreozzi M, Giacchetto M, Carrara S, Ferrari C, Binda C, Mangiavillano B, Anderloni A, Repici A. Use of endoscopic ultrasound-guided gallbladder drainage as a rescue approach in cases of unsuccessful biliary drainage. World J Gastroenterol 2024; 30:70-78. [PMID: 38293324 PMCID: PMC10823897 DOI: 10.3748/wjg.v30.i1.70] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/14/2023] [Accepted: 12/22/2023] [Indexed: 01/06/2024] Open
Abstract
This narrative review provides an overview of the utilization of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) as a salvage approach in cases of unsuccessful conventional management. EUS-GBD is a minimally invasive and effective technique for drainage in patients with acute cholecystitis with high risk of surgery. The procedure has demonstrated impressive technical and clinical success rates with low rates of adverse events, making it a safe and effective option for appropriate candidates. Furthermore, EUS-GBD can also serve as a rescue option for patients who have failed endoscopic retrograde cholangiopancreatography or EUS biliary drainage for relief of jaundice in malignant biliary stricture. However, patient selection is critical for the success of EUS-GBD, and proper patient selection and risk assessment are important to ensure the safety and efficacy of the procedure. As the field continues to evolve and mature, ongoing research will further refine our understanding of the benefits and limitations of EUS-GBD, ultimately leading to improved outcomes for patients.
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Affiliation(s)
- Alessandro Fugazza
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital - IRCCS, Rozzano 20089, Milano, Italy
| | - Kareem Khalaf
- Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto M5B 1W8, ON, Canada
| | - Katarzyna M Pawlak
- Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto M5B 1W8, ON, Canada
| | - Marco Spadaccini
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital - IRCCS, Rozzano 20089, Milano, Italy
| | - Matteo Colombo
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital - IRCCS, Rozzano 20089, Milano, Italy
| | - Marta Andreozzi
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital - IRCCS, Rozzano 20089, Milano, Italy
| | - Marco Giacchetto
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital - IRCCS, Rozzano 20089, Milano, Italy
| | - Silvia Carrara
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital - IRCCS, Rozzano 20089, Milano, Italy
| | - Chiara Ferrari
- Department of Anesthesia, Humanitas Research Hospital - IRCCS, Rozzano 20089, Milano, Italy
| | - Cecilia Binda
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, Romagna 47121, Italy
| | | | - Andrea Anderloni
- Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia 27100, Italy
| | - Alessandro Repici
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital - IRCCS, Rozzano 20089, Milano, Italy
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Barragan C, Alshehri H, Marom G, Glazer Y, Swanstrom L, Shlomovitz E. A Pilot Study of Percutaneous Cholecystoenteric Anastomosis: A New Option for High-Risk Patients with Symptomatic Gallstones. J Vasc Interv Radiol 2024; 35:74-79. [PMID: 37797738 DOI: 10.1016/j.jvir.2023.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 08/27/2023] [Accepted: 09/24/2023] [Indexed: 10/07/2023] Open
Abstract
PURPOSE To evaluate the safety and effectiveness of percutaneous cholecystoenteric anastomosis (PCEA) creation in patients with indwelling cholecystostomy tubes who are high-risk surgical candidates. MATERIALS AND METHODS Fourteen (male, 10; female, 4) patients with a mean age of 79 years (range, 53-92 years) with previously inserted cholecystostomy tubes underwent PCEA with the adjacent duodenum using a lumen-apposing metal stent (LAMS) between January 2015 and October 2022. Intraprocedural adverse events and postprocedural safety and effectiveness outcomes were evaluated. Nine procedures were performed under sedation and 5 under general anesthesia. RESULTS Technical success was achieved in 100% of the patients. In 12 patients (86%), the existing cholecystostomy tube was removed after the insertion of the LAMS. Three patients (21%) had a pre-existing cholecystoduodenal fistula, in which the stent was placed, and 11 (79%) underwent creation of a de novo anastomosis. The mean procedure time was 1.5 hours (range, 1-2 hours). The mean length of stay after the procedure was 2.4 days (range, 1-10 days). There were no intraprocedural adverse events. One patient with severe pre-existing cardiac comorbidities died during his postprocedural stay despite a technically successful procedure. One patient had delayed closure of the long-standing cholecystocutaneous tract. CONCLUSIONS Early clinical experience with PCEA using an LAMS suggests that it is a safe and effective option for the creation of internal gallbladder drainage in patients who are not candidates for surgical cholecystectomy.
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Affiliation(s)
- Camilo Barragan
- Division of Vascular and Interventional Radiology, University Health Network, Toronto, Canada.
| | - Hassan Alshehri
- Division of Vascular and Interventional Radiology, University Health Network, Toronto, Canada
| | - Gad Marom
- Division of General Surgery, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yair Glazer
- Division of Vascular and Interventional Radiology, University Health Network, Toronto, Canada
| | - Lee Swanstrom
- Institut de Chirurgie guidée par l'Image (IHU), Strasbourg, France
| | - Eran Shlomovitz
- Division of Vascular and Interventional Radiology, University Health Network, Toronto, Canada; Division of General Surgery, University Health Network, Toronto, Canada
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Grover D, Fatima I, Dharan M. Comparison of trans-gastric vs trans-enteric (trans-duodenal or trans-jejunal) endoscopic ultrasound guided gallbladder drainage using lumen apposing metal stents. World J Gastrointest Endosc 2023; 15:574-583. [PMID: 37744320 PMCID: PMC10514705 DOI: 10.4253/wjge.v15.i9.574] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/25/2023] [Accepted: 08/23/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Endoscopic ultrasound guided gallbladder drainage (EUS-GBD) is being increasingly used in practice (either as a bridge to cholecystectomy in high-risk patients or as destination therapy in non-surgical patients). Stents are used to create a conduit between the lumen of the gallbladder (GB) and the intestinal lumen through the gastric or enteric routes. Among the various types of stents used, cautery-enhanced lumen apposing metallic stents (LAMS) may be associated with fewer adverse events (AEs). AIM To compare the clinical success, technical success, and rate of AEs between transgastric (TG) and trans-enteric [transduodenal (TD)/transjejunal (TJ)] approach to GB drainage. Further, we analyzed whether using cautery enhanced stents during EUS-GBD impacts the above parameters. METHODS Study was registered in PROSPERO (CRD42022319019) and comprehensive literature review was conducted. Manuscripts were reviewed for the data collection: Rate of AEs, clinical success, and technical success. Random effects model was utilized for the analysis. RESULTS No statistically significant difference in clinical and technical success between the TD/TJ and TG approaches (P > 0.05) were noted. There was no statistically significant difference in the rate of AEs when comparing two-arm studies only. However, when all studies were included in the analysis difference was almost significant favoring the TD/TJ approach. When comparing cautery-enhanced LAMS with non-cautery enhanced LAMS, a statistically significant difference in the rate of AEs was observed when all the studies were included, with the rate being higher in non-cautery enhanced stents (14.0% vs 37.8%; P < 0.01). CONCLUSION As per our study results, TD/TJ approach appears to be associated with lower rate of adverse events and comparable efficacy when compared to the TG approach for the EUS-GBD. Additionally, use of cautery-enhanced LAMS for EUS-GBD is associated with a more favorable adverse event profile compared to cold LAMS. Though the approach chosen depends on several patient and physician factors, the above findings could help in deciding the ideal drainage route when both TG and TD/TJ approaches are feasible.
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Affiliation(s)
- Dheera Grover
- Department of Internal Medicine, University of Connecticut, Farmington, CT 06030, United States
| | - Ifrah Fatima
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO 64110, United States
| | - Murali Dharan
- Department of Gastroenterology and Hepatology, University of Connecticut Health Center, Farmington, CT 06030, United States
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Irani SS, Sharma NR, Storm AC, Shah RJ, Chahal P, Willingham FF, Swanstrom L, Baron TH, Shlomovitz E, Kozarek RA, Peetermans JA, McMullen E, Ho E, van der Merwe SW. Endoscopic Ultrasound-guided Transluminal Gallbladder Drainage in Patients With Acute Cholecystitis: A Prospective Multicenter Trial. Ann Surg 2023; 278:e556-e562. [PMID: 36537290 PMCID: PMC10414151 DOI: 10.1097/sla.0000000000005784] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate the safety and efficacy of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using a lumen-apposing metal stent (LAMS). BACKGROUND For patients with acute cholecystitis who are poor surgical candidates, EUS-GBD using a LAMS is an important treatment alternative to percutaneous gallbladder drainage. METHODS We conducted a regulatory-compliant, prospective multicenter trial at 7 tertiary referral centers in the United States of America and Belgium. Thirty consecutive patients with mild or moderate acute cholecystitis who were not candidates for cholecystectomy were enrolled between September 2019 and August 2021. Eligible patients had a LAMS placed transmurally with 30 to 60-day indwell if removal was clinically indicated, and 30-day follow-up post-LAMS removal. Endpoints included days until acute cholecystitis resolution, reintervention rate, acute cholecystitis recurrence rate, and procedure-related adverse events (AEs). RESULTS Technical success was 93.3% (28/30) for LAMS placement and 100% for LAMS removal in 19 patients for whom removal was attempted. Five (16.7%) patients required reintervention. Mean time to acute cholecystitis resolution was 1.6±1.5 days. Acute cholecystitis symptoms recurred in 10.0% (3/30) after LAMS removal. Five (16.7%) patients died from unrelated causes. Procedure-related AEs were reported to the FDA in 30.0% (9/30) of patients, including one fatal event 21 days after LAMS removal; however, no AEs were causally related to the LAMS. CONCLUSIONS For selected patients with acute cholecystitis who are at elevated surgical risk, EUS-GBD with LAMS is an alternative to percutaneous gallbladder drainage. It has high technical and clinical success, with low recurrence and an acceptable AE rate. Clinicaltrials.gov, Number: NCT03767881.
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Affiliation(s)
- Shayan S. Irani
- Division of Gastroenterology, Virginia Mason Medical Center, Seattle, WA
| | - Neil R. Sharma
- Division of Interventional Oncology and Surgical Endoscopy (IOSE), Parkview Cancer Institute, Ft. Wayne, IN
| | - Andrew C. Storm
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Raj J. Shah
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Prabhleen Chahal
- Division of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Cleveland, OH
| | - Field F. Willingham
- Division of Digestive Diseases, Department of Medicine, Emory University, Atlanta, GA
| | - Lee Swanstrom
- IHU—Strasbourg, Institute for Image Guided Surgery, Strasbourg, France
| | - Todd H. Baron
- Division of Gastroenterology and Hepatology, Director of Advanced Therapeutic Endoscopy, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Eran Shlomovitz
- Department of Interventional Radiology, University of Toronto, Toronto, ON, Canada
| | - Richard A. Kozarek
- Division of Gastroenterology, Virginia Mason Medical Center, Seattle, WA
| | | | - Edmund McMullen
- Endoscopy Division, Boston Scientific Corporation, Marlborough, MA
| | - Evelyne Ho
- Endoscopy Division, Boston Scientific Corporation, Marlborough, MA
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Medas R, Ferreira-Silva J, Girotra M, Barakat M, Tabibian JH, Rodrigues-Pinto E. Best Practices in Pancreatico-biliary Stenting and EUS-guided Drainage. J Clin Gastroenterol 2023; 57:553-568. [PMID: 36040964 DOI: 10.1097/mcg.0000000000001760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Indications for endoscopic placement of endoluminal and transluminal stents have greatly expanded over time. Endoscopic stent placement is now a well-established approach for the treatment of benign and malignant biliary and pancreatic diseases (ie, obstructive jaundice, intra-abdominal fluid collections, chronic pancreatitis etc.). Ongoing refinement of technical approaches and development of novel stents is increasing the applicability and success of pancreatico-biliary stenting. In this review, we discuss the important developments in the field of pancreatico-biliary stenting, with a specific focus on endoscopic retrograde cholangiopancreatography and endoscopic ultrasound-associated developments.
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Affiliation(s)
- Renato Medas
- Gastroenterology Department, Centro Hospitalar São João
- Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Joel Ferreira-Silva
- Gastroenterology Department, Centro Hospitalar São João
- Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Mohit Girotra
- Digestive Health Institute, Swedish Medical Center, Seattle, WA
| | | | - James H Tabibian
- Division of Gastroenterology, Department of Medicine, Olive View-UCLA Medical Center, Sylmar
- UCLA Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA CA
| | - Eduardo Rodrigues-Pinto
- Gastroenterology Department, Centro Hospitalar São João
- Faculty of Medicine of the University of Porto, Porto, Portugal
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Tyberg A, Duarte-Chavez R, Shahid HM, Sarkar A, Simon A, Shah-Khan SM, Gaidhane M, Mohammad TF, Nosher J, Wise SS, Needham V, Kheng M, Lajin M, Sojitra B, Wey B, Dorwat S, Raina H, Ansari J, Gandhi A, Bapaye A, Shah-Khan SM, Krafft MR, Thakkar S, Singh S, Bane JR, Nasr JY, Lee DP, Kedia P, Arevalo-Mora M, Del Valle RS, Robles-Medranda C, Puga-Tejada M, Vanella G, Ardengh JC, Bilal M, Giuseppe D, Arcidiacono PG, Kahaleh M. Endoscopic Ultrasound-Guided Gallbladder Drainage Versus Percutaneous Drainage in Patients With Acute Cholecystitis Undergoing Elective Cholecystectomy. Clin Transl Gastroenterol 2023; 14:e00593. [PMID: 37141073 PMCID: PMC10299765 DOI: 10.14309/ctg.0000000000000593] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 04/18/2023] [Indexed: 05/05/2023] Open
Abstract
INTRODUCTION Cholecystectomy (CCY) is the gold standard treatment of acute cholecystitis (AC). Nonsurgical management of AC includes percutaneous transhepatic gallbladder drainage (PT-GBD) and endoscopic ultrasound-guided gallbladder drainage (EUS-GBD). This study aims to compare outcomes of patients who undergo CCY after having received EUS-GBD vs PT-GBD. METHODS A multicenter international study was conducted in patients with AC who underwent EUS-GBD or PT-GBD, followed by an attempted CCY, between January 2018 and October 2021. Demographics, clinical characteristics, procedural details, postprocedure outcomes, and surgical details and outcomes were compared. RESULTS One hundred thirty-nine patients were included: EUS-GBD in 46 patients (27% male, mean age 74 years) and PT-GBD in 93 patients (50% male, mean age 72 years). Surgical technical success was not significantly different between the 2 groups. In the EUS-GBD group, there was decreased operative time (84.2 vs 165.4 minutes, P < 0.00001), time to symptom resolution (4.2 vs 6.3 days, P = 0.005), and length of stay (5.4 vs 12.3 days, P = 0.001) compared with the PT-GBD group. There was no difference in the rate of conversion from laparoscopic to open CCY: 5 of 46 (11%) in the EUS-GBD arm and 18 of 93 (19%) in the PT-GBD group ( P value 0.2324). DISCUSSION Patients who received EUS-GBD had a significantly shorter interval between gallbladder drainage and CCY, shorter surgical procedure times, and shorter length of stay for the CCY compared with those who received PT-GBD. EUS-GBD should be considered an acceptable modality for gallbladder drainage and should not preclude patients from eventual CCY.
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Affiliation(s)
- Amy Tyberg
- Endoscopy, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA;
| | | | - Haroon M. Shahid
- Endoscopy, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA;
| | - Avik Sarkar
- Endoscopy, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA;
| | - Alexa Simon
- Endoscopy, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA;
| | - Sardar M. Shah-Khan
- Endoscopy, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA;
| | - Monica Gaidhane
- Endoscopy, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA;
| | - Tayyaba F. Mohammad
- Endoscopy, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA;
| | - John Nosher
- Endoscopy, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA;
| | - Susannah S. Wise
- Endoscopy, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA;
| | - Victoria Needham
- Endoscopy, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA;
| | - Marin Kheng
- Endoscopy, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA;
| | | | - Badal Sojitra
- Endoscopy, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA;
| | - Bryan Wey
- Endoscopy, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA;
| | | | | | | | | | | | | | | | - Shyam Thakkar
- West Virginia University, Morgantown, West Virginia, USA
| | | | - Janele R. Bane
- West Virginia University, Morgantown, West Virginia, USA
| | - John Y. Nasr
- West Virginia University, Morgantown, West Virginia, USA
| | - David P. Lee
- Methodist Dallas Medical Center, Dallas, Texas, USA
| | | | | | | | | | | | | | | | - Mohammad Bilal
- Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
| | | | | | - Michel Kahaleh
- Endoscopy, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA;
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10
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Wang S, Guo J, Liu X, Ge N, Wang G, Hu J, Zhang K, Sun S. Evaluation of a novel radial echoendosonoscope with a piezoelectric-composite transducer: An open-label, multicenter, randomized, parallel-group, noninferiority clinical trial. Endosc Ultrasound 2021; 10:431-439. [PMID: 34975041 PMCID: PMC8785674 DOI: 10.4103/eus-d-21-00100] [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: 11/04/2022] Open
Abstract
BACKGROUND AND OBJECTIVES EUS is widely used in the clinical practice. This study aimed to evaluate the efficacy of a novel echoendoscope regarding image quality, maneuverability, stability of the entire machine system, and safety. SETTING AND DESIGN We conducted this open-label, multicenter, randomized, parallel-group, noninferiority clinical trial in three tertiary hospitals between November 2018 and April 2019. SUBJECTS AND METHODS One hundred and thirty patients were included. The stratified segment randomization method was employed. Sixty-five patients in the test group received an EUS examination using the new material radial echoendoscope, and 65 patients in the control group received an EUS examination using the existing endoscope. We recorded the image quality, maneuverability, stability of the entire machine system, and safety. For the main outcome, comprehensive image quality, the groups were compared with the noninferiority test, using the confidence interval method and 10% as the noninferiority threshold. The Pearson Chi-square test was used to compare the incidence of adverse events between the groups. RESULTS Sixty-five patients in the test group and 63 patients in the control group were analyzed. Two patients in control group did not complete an EUS examination due to machine problems. There were no significant differences in image quality, maneuverability of the echoendoscope, stability of the entire machine system, and safety between the groups. CONCLUSIONS This new material radial echoendoscope showed good capabilities for image quality, maneuverability, stability of the entire machine system, and safety. Our data suggest that the new echoendoscope may provide an additional option for endoscopic physicians.
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Affiliation(s)
- Sheng Wang
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Jintao Guo
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Xiang Liu
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Nan Ge
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Guoxin Wang
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Jinlong Hu
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Kai Zhang
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Siyu Sun
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
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11
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Lin SN, Mao R, Qian C, Bettenworth D, Wang J, Li J, Bruining D, Jairath V, Feagan B, Chen M, Rieder F. Development of Anti-fibrotic Therapy in Stricturing Crohn's Disease: Lessons from Randomized Trials in Other Fibrotic Diseases. Physiol Rev 2021; 102:605-652. [PMID: 34569264 DOI: 10.1152/physrev.00005.2021] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Intestinal fibrosis is considered an inevitable complication of Crohn's disease (CD) that results in symptoms of obstruction and stricture formation. Endoscopic or surgical treatment is required to treat the majority of patients. Progress in the management of stricturing CD is hampered by the lack of effective anti-fibrotic therapy; however, this situation is likely to change because of recent advances in other fibrotic diseases of the lung, liver and skin. In this review, we summarized data from randomized controlled trials (RCT) of anti-fibrotic therapies in these conditions. Multiple compounds have been tested for the anti-fibrotic effects in other organs. According to their mechanisms, they were categorized into growth factor modulators, inflammation modulators, 5-hydroxy-3-methylgultaryl-coenzyme A (HMG-CoA) reductase inhibitors, intracellular enzymes and kinases, renin-angiotensin system (RAS) modulators and others. From our review of the results from the clinical trials and discussion of their implications in the gastrointestinal tract, we have identified several molecular candidates that could serve as potential therapies for intestinal fibrosis in CD.
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Affiliation(s)
- Si-Nan Lin
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States.,Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Ren Mao
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States.,Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Chenchen Qian
- Department of Internal Medicine, UPMC Pinnacle, Harrisburg, Pennsylvania, United States
| | - Dominik Bettenworth
- Department of Medicine B, Gastroenterology and Hepatology, University Hospital Münster, Münster, Germany
| | - Jie Wang
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States.,Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, United States.,Henan Key Laboratory of Immunology and Targeted Drug, Xinxiang Medical University, Xinxiang, Henan Province, China
| | - Jiannan Li
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States.,Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - David Bruining
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, United States
| | - Vipul Jairath
- Alimentiv Inc., London, ON, Canada.,Department of Medicine, Western University, London, ON, Canada.,Department of Biostatistics and Epidemiology, Western University, London, ON, Canada
| | - Brian Feagan
- Alimentiv Inc., London, ON, Canada.,Department of Medicine, Western University, London, ON, Canada.,Department of Biostatistics and Epidemiology, Western University, London, ON, Canada
| | - Minhu Chen
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | | | - Florian Rieder
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States.,Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, United States
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12
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Abstract
Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has emerged as a safe and effective minimally invasive alternative to both percutaneous and endoscopic transpapillary GBD in patients with acute cholecystitis. Over the last few years, the technique, as well as the indications for EUS-GBD have been gradually evolving, and the procedure has become simpler and safer as the accepted indications have expanded. The development of lumen-apposing metal stents (LAMS) has allowed us to realize the dream of creating endoscopic gastrointestinal anastomoses, and has thus paved the way for a safer EUS-GBD. Single step EUS-guided LAMS delivery systems have obviated the use of other endoscopic accessories and thus made EUS-GBD simpler and safer. However, EUS-GBD can be associated with potentially serious complications, and therefore should be performed by expert interventional endosonologists at centers with surgical and radiological back up. EUS-GBD is a relatively new procedure still in its infancy, but continued improvement in EUS accessories and dedicated stents will make this procedure safer and also expand its current indications. This review focuses on the technical aspects, including procedural details, as well as the complications of EUS-GBD.
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Affiliation(s)
- Surinder S Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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