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Hayat M, Xiao Y, Arain MA, Yang D. Endoscopic Gallbladder Drainage EUS LAMS vs. ERCP Trans-papillary Drainage. Curr Gastroenterol Rep 2025; 27:5. [PMID: 39549140 DOI: 10.1007/s11894-024-00948-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2024] [Indexed: 11/18/2024]
Abstract
PURPOSE OF REVIEW In this review, we discuss the role of endoscopic gallbladder drainage for acute cholecystitis in non-surgical candidates, describe technical aspects, clinical outcomes, and elaborate on considerations when determining which approach to adopt for a given patient. RECENT FINDINGS Cholecystectomy remains the criterion standard for management of acute cholecystitis in patients who can safely undergo surgery. For non-surgical candidates, percutaneous cholecystostomy (PTC-GBD) has been the traditional strategy to drain and decompress the gallbladder. Advances in endoscopy have further expanded the nonsurgical interventions and approaches to cholecystitis. Both endoscopic transpapillary gallbladder drainage (ET-GBD) and endoscopic ultrasound guided gallbladder drainage (EUS-GBD) have become acceptable alternatives to PTC-GBD, with growing literature supporting their efficacy, safety and improved patient quality of life when compared to a percutaneous approach. Choosing the appropriate endoscopic technique for gallbladder drainage should be tailored to each patient, keeping in view the specific clinical scenarios, endoscopist preference and following a multi-disciplinary approach.
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Affiliation(s)
- Maham Hayat
- Center for Interventional Endoscopy, AdventHealth, 601 E Rollins St, Orlando, FL, 32803, USA
| | - Yasi Xiao
- Center for Interventional Endoscopy, AdventHealth, 601 E Rollins St, Orlando, FL, 32803, USA
| | - Mustafa A Arain
- Center for Interventional Endoscopy, AdventHealth, 601 E Rollins St, Orlando, FL, 32803, USA
| | - Dennis Yang
- Center for Interventional Endoscopy, AdventHealth, 601 E Rollins St, Orlando, FL, 32803, USA.
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Argandykov D, El Moheb M, Nzenwa IC, Kalva SP, Iqbal S, Smolinski-Zhao S, Krishnan K, Velmahos GC, Paranjape C. Percutaneous and endoscopic transpapillary cholecystoduodenal stenting in acute cholecystitis-A viable long-term option in high-risk patients? J Trauma Acute Care Surg 2025; 98:319-326. [PMID: 39560954 DOI: 10.1097/ta.0000000000004468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2024]
Abstract
BACKGROUND The prolonged use of percutaneous cholecystostomy tubes (PCTs) in patients with acute cholecystitis, deemed inoperable, is fraught with complications. Transpapillary cholecystoduodenal stenting (TCDS) is an alternative technique that restores the physiologic outflow of bile, avoiding the need for an external drain. However, the long-term safety and efficacy of this approach remain unclear. We sought to prospectively assess the safety and efficacy of this procedure, performed via percutaneous or endoscopic approach, in high-risk patients presenting with acute cholecystitis. METHODS This prospective study included consecutive patients with acute cholecystitis and long-lasting, prohibitive surgical risk, in whom TCDS was offered at two partnering tertiary care centers between August 1, 2018, and December 31, 2022. Patients with a need for endoscopic retrograde cholangiopancreatography (ERCP) underwent ERCP-guided TCDS. In patients without a need for ERCP, a temporary PCT was followed by fluoroscopic-guided TCDS 4 weeks to 6 weeks later. Interval cholecystectomy was performed in patients who became surgical candidates later. All patients were followed up until January 1, 2023. RESULTS Transpapillary cholecystoduodenal stenting was successful in 67 (percutaneous in 45/50; endoscopic in 22/23) of 73 patients (92%) attempted. Over a median follow-up period of 17 months (7, 26), 10 patients (15%) developed stent blockage or migration; all but two had their stent successfully replaced. Five patients (7%) developed mild, self-limited pancreatitis. Five (7%) patients underwent interval cholecystectomy at a median time of 7 months. CONCLUSION Transpapillary cholecystoduodenal stenting is a safe and promising definitive alternative to chronic PCT in high-risk patients with acute cholecystitis that eliminates the discomfort and complications of long-term external drainage. LEVEL OF EVIDENCE Therapeutic/Care Management; Level II.
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Affiliation(s)
- Dias Argandykov
- From the Division of Trauma, Emergency Surgery, Surgical Critical Care (D.A., M.E.M., I.C.N., G.C.V., C.P.), Division of Interventional Radiology (S.P.K., S.I., S.S.-Z.), Massachusetts General Hospital; Division of Interventional Radiology (S.P.K., S.I., S.S.-Z.), Newton-Wellesley Hospital; and Division of Gastroenterology (K.K.), Massachusetts General Hospital, Boston, Massachusetts
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Cooper KM, Winkie M, Achebe I, Devuni D, Mehta S. Endoscopic transpapillary gallbladder drainage is associated with favorable long-term outcomes in patients with advanced liver disease. Endosc Int Open 2025; 13:a24724256. [PMID: 40012578 PMCID: PMC11863550 DOI: 10.1055/a-2472-4256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Accepted: 11/15/2024] [Indexed: 02/28/2025] Open
Abstract
Background and study aims Endoscopic gallbladder therapy is increasingly used in high-risk surgical patients, but data in advanced liver disease are lacking. Patients and methods We performed a single-center retrospective analysis of patients with cirrhosis undergoing endoscopic transpapillary gallbladder drainage (ET-GBD) with cystic duct stenting (n = 55). Short-term outcomes were assessed at Day 30. Long-term outcomes were assessed at 6 months and 1 and 3 years or last known follow-up. Subgroup analyses were completed by location (inpatient vs. outpatient). Results A total of 52 patients, mean MELD-Na 16, underwent successful ET-GBD (38 inpatient, 14 outpatient). Most patients (n = 48) experienced immediate symptomatic relief. Short-term adverse event rate was 7.7% and 30-day mortality was 1.9%. At 6 months, 86.5% of patients had a favorable outcome; unfavorable outcomes included death (n = 2), recurrent cholecystitis and/or need for urgent cholecystectomy (n = 5). At the end of the study, 80% of patients experienced a favorable outcome including five patients bridged to liver transplant and 20 who had their stent in place with adequate symptom control. Of those with imaging, 65% of patients experienced resolution of cholelithiasis. Recurrent cholecystitis ( P = 1.00) and stone resolution ( P = 0.35) did not differ in patients with one or two cystic duct stents in place. Conclusions Transpapillary gallbladder stenting is technically feasible and associated with high rates of clinical success in patients with decompensated liver disease. Stone resolution is common after transpapillary gallbladder stenting and may portend favorable patient outcomes.
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Affiliation(s)
| | - Mason Winkie
- Medicine, UMass Chan Medical School, Worcester, United States
| | - Ikechukwu Achebe
- Medicine, Division of Gastroenterology and Hepatology, UMass Chan Medical School, Worcester, United States
| | - Deepika Devuni
- Medicine, Division of Gastroenterology and Hepatology, UMass Chan Medical School, Worcester, United States
| | - Savant Mehta
- Medicine, Division of Gastroenterology and Hepatology, UMass Chan Medical School, Worcester, United States
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Adachi A, Yoshida M, Hori Y, Kato A, Kachi K, Sahashi H, Toyohara T, Kuno K, Kito Y, Kataoka H. Innovative use of a 3-Fr microcatheter for precision guidewire placement with digital single-operator cholangioscopy for pancreaticobiliary drainage (with video). Sci Rep 2024; 14:30647. [PMID: 39730389 DOI: 10.1038/s41598-024-75692-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 10/08/2024] [Indexed: 12/29/2024] Open
Abstract
Biliary and pancreatic tract stenosis are hallmark symptoms in pancreaticobiliary diseases, transcending malignancy. Endoscopic techniques are pivotal for biliary/pancreatic drainage; however, challenging scenarios arise when attempting to pass a guidewire (GW) through obstruction. Cholangioscopy-assisted GW placement has proven valuable, but challenges persist in its execution, particularly in maneuvering the GW through cholangioscopy. Therefore, we explored the integration of a 3-Fr microcatheter into cholangioscopy with the aim of enhancing direct visualization and offering a super-selective approach. When GW manipulation under a digital single-operator cholangioscope (D-SOC) guidance was still unsuccessful in a resistant obstruction, the 3-Fr microcatheter was introduced. This technique was performed in 42 individuals for 37 biliary and 5 pancreatic duct drainages, among which there were 19 malignant, 18 benign, and 4 anastomotic obstructions. In all patients, contrast-filled cholangiography in the target area couldn't be achieved at the pre-microcatheter insertion stage due to obstruction. The technical success rate was 85.7% overall, 89.5% in malignant strictures, 84.2% in benign strictures, and 75.0% in anastomotic obstructions, resulting in a clinical success rate of 78.6%. The use of a 3-Fr microcatheter appears effective for endoscopic drainage performed for obstruction. This technique could pave the way for improved outcomes in patients with pancreaticobiliary diseases.
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Affiliation(s)
- Akihisa Adachi
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku Nagoya, Nagoya, Aichi, 467-8601, Japan
| | - Michihiro Yoshida
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku Nagoya, Nagoya, Aichi, 467-8601, Japan.
| | - Yasuki Hori
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku Nagoya, Nagoya, Aichi, 467-8601, Japan
| | - Akihisa Kato
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku Nagoya, Nagoya, Aichi, 467-8601, Japan
| | - Kenta Kachi
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku Nagoya, Nagoya, Aichi, 467-8601, Japan
| | - Hidenori Sahashi
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku Nagoya, Nagoya, Aichi, 467-8601, Japan
| | - Tadashi Toyohara
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku Nagoya, Nagoya, Aichi, 467-8601, Japan
| | - Kayoko Kuno
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku Nagoya, Nagoya, Aichi, 467-8601, Japan
| | - Yusuke Kito
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku Nagoya, Nagoya, Aichi, 467-8601, Japan
| | - Hiromi Kataoka
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku Nagoya, Nagoya, Aichi, 467-8601, Japan
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Niiya F, Tamai N, Yamawaki M, Noda J, Azami T, Takano Y, Nishimoto F, Nagahama M. Benefits of endoscopic gallbladder stenting following percutaneous transhepatic gallbladder drainage. World J Gastrointest Surg 2024; 16:2902-2909. [PMID: 39351569 PMCID: PMC11438794 DOI: 10.4240/wjgs.v16.i9.2902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 07/10/2024] [Accepted: 08/05/2024] [Indexed: 09/18/2024] Open
Abstract
BACKGROUND Endoscopic transpapillary gallbladder drainage is challenging because of the complexity of the procedure and high incidence of adverse events (AEs). To overcome these problems, endoscopic gallbladder stenting (EGBS) after percutaneous transhepatic gallbladder drainage (PTGBD) can be effective, as it mitigates inflammation and adhesion. AIM To examine the benefits of EGBS after PTGBD to assess its efficacy and impact on AEs. METHODS We retrospectively analyzed data from 35 patients who underwent EGBS after PTGBD at a single center between January 2016 and December 2023. The primary outcomes were technical success and AEs, and the rate of recurrent cholecystitis was evaluated. In addition, the reasons for the failure of the procedure were identified. RESULTS Among the 35 patients, the technical success rate was 77.1% and the final contrast of the cystic duct was successful in 97.1% of patients. The incidence of early AEs was relatively low (11.4%), with no instances of cystic duct perforation. The rate of recurrent cholecystitis was 3.7%, and no other biliary events were observed. CONCLUSION EGBS after PTGBD may be significantly beneficial, with a substantial success rate and minimal AEs in both short- and long-term follow-ups.
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Affiliation(s)
- Fumitaka Niiya
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama 227-8501, Kanagawa, Japan
| | - Naoki Tamai
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama 227-8501, Kanagawa, Japan
| | - Masataka Yamawaki
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama 227-8501, Kanagawa, Japan
| | - Jun Noda
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama 227-8501, Kanagawa, Japan
| | - Tetsushi Azami
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama 227-8501, Kanagawa, Japan
| | - Yuichi Takano
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama 227-8501, Kanagawa, Japan
| | - Fumiya Nishimoto
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama 227-8501, Kanagawa, Japan
| | - Masatsugu Nagahama
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama 227-8501, Kanagawa, Japan
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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] [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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Tong T, Tian L, Deng MZ, Chen XJ, Fu T, Ma KJ, Xu JH, Wang XY. The efficacy and safety of endoscopic ultrasound-guided fine-needle biopsy in gallbladder masses. Hepatobiliary Pancreat Dis Int 2023; 22:632-638. [PMID: 35331650 DOI: 10.1016/j.hbpd.2022.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 02/28/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) is a widely used modality for acquiring various target samples, but its efficacy in gallbladder masses is unknown. The aim of this retrospective study was to evaluate the efficacy and safety of EUS-FNB in patients with gallbladder masses. METHODS The study samples were composed of patients from March 2015 to July 2019 who needed to identify the nature of gallbladder masses through EUS-FNB. The outcomes of this study were the adequacy of specimens, diagnostic yields, technical feasibility, and adverse events of the EUS-FNB in gallbladder masses. RESULTS A total of 27 consecutive patients with a median age of 58 years were included in this study. The 22-gauge FNB needle was feasible in all lesions. The median follow-up period of the patients was 294 days. The specimens sufficient for diagnosis account for 89% (24/27) and 93% (25/27) in cytology and histology, respectively. The overall diagnostic yields for malignancy showed the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 95.45% [95% confidence interval (CI): 75.12%-99.76%], 100% (95% CI: 46.29%-100%), 100% (95% CI: 80.76%-100%), 83.33% (95% CI: 36.48%-99.12%), and 96.30% (95% CI: 80.20%-99.99%), respectively. The subgroup analysis revealed that FNB could obtain sufficient specimens and high diagnostic yields in both gallbladder mass < 20.5 mm group and ≥ 20.5 mm group. One patient experienced mild abdominal pain after the procedure and recovered within one day. CONCLUSIONS EUS-FNB is a reasonable diagnostic tool for the pretreatment diagnosis of patients with gallbladder masses, especially for patients who may miss the opportunity of surgery and need sufficient specimens to identify the pathological type so as to determine chemotherapy regimens. Further large-scale studies are needed to confirm our conclusion.
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Affiliation(s)
- Ting Tong
- Endoscopic Center, Department of Gastroenterology, the Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road Yuelu District, Changsha 410013, China
| | - Li Tian
- Endoscopic Center, Department of Gastroenterology, the Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road Yuelu District, Changsha 410013, China
| | - Min-Zi Deng
- Endoscopic Center, Department of Gastroenterology, the Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road Yuelu District, Changsha 410013, China
| | - Xue-Jie Chen
- Endoscopic Center, Department of Gastroenterology, the Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road Yuelu District, Changsha 410013, China
| | - Tian Fu
- Endoscopic Center, Department of Gastroenterology, the Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road Yuelu District, Changsha 410013, China
| | - Ke-Jia Ma
- Endoscopic Center, Department of Gastroenterology, the Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road Yuelu District, Changsha 410013, China
| | - Jia-Hao Xu
- Endoscopic Center, Department of Gastroenterology, the Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road Yuelu District, Changsha 410013, China
| | - Xiao-Yan Wang
- Endoscopic Center, Department of Gastroenterology, the Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road Yuelu District, Changsha 410013, China.
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Sato J, Nakahara K, Michikawa Y, Morita R, Suetani K, Sekine A, Igarashi Y, Kobayashi S, Otsubo T, Itoh F. Clinical outcomes and predictors of technical failure of endoscopic transpapillary gallbladder drainage in acute cholecystitis. Scand J Gastroenterol 2023; 58:286-290. [PMID: 36069161 DOI: 10.1080/00365521.2022.2118554] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Endoscopic transpapillary gallbladder drainage (ETGBD) has been performed as an alternative therapy against cholecystectomy in patients with acute cholecystitis. To date, few studies have reported the safety, efficacy, and factors affecting ETGBD. We evaluated the clinical outcomes and predictors of technical failure of ETGBD. METHODS Patients with acute cholecystitis who underwent ETGBD were retrospectively reviewed, and consecutive patients were included in the study. The technical success rate, clinical success rate, adverse events, and the predictors associated with the technical failure of ETGBD were investigated. RESULTS A total of 242 patients were enrolled in the study. The technical success rate of ETGBD and clinical success rate of technically successful ETGBD cases were 87% and 93%, respectively. We experienced cystic duct injury in 24 patients as an ETGBD-related adverse event, and pancreatitis in 12 patients as an endoscopic retrograde cholangiopancreatography-related adverse event. Multivariate analysis indicated that cystic duct injury was the independent predictor associated with the technical failure of ETGBD (odds ratio, 11; 95% confidence interval, 3.9-29; p < 0.001). CONCLUSIONS ETGBD was a safe and effective treatment method for acute cholecystitis with acceptable adverse events. There was no predictor based on the information from patient characteristics; however, cystic duct injury was associated with the technical failure of ETGBD.
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Affiliation(s)
- Junya Sato
- Department of Gastroenterology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Kazunari Nakahara
- Department of Gastroenterology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Yosuke Michikawa
- Department of Gastroenterology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Ryo Morita
- Department of Gastroenterology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Keigo Suetani
- Department of Gastroenterology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Akihiro Sekine
- Department of Gastroenterology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Yosuke Igarashi
- Department of Gastroenterology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Shinjiro Kobayashi
- Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Takehito Otsubo
- Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Fumio Itoh
- Department of Gastroenterology, St. Marianna University School of Medicine, Kanagawa, Japan
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Yoshida M, Naitoh I, Hayashi K, Hori Y, Kato A, Kachi K, Asano G, Sahashi H, Toyohara T, Kuno K, Kito Y, Kataoka H. Theoretical step approach with 'Three-pillar' device assistance for successful endoscopic transpapillary gallbladder drainage. PLoS One 2023; 18:e0281605. [PMID: 36758010 PMCID: PMC9910654 DOI: 10.1371/journal.pone.0281605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 01/26/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Endoscopic transpapillary gallbladder drainage (ETGBD) has been reported as an alternative procedure for acute cholecystitis but remains a challenging procedure. AIMS To elucidate the efficacy of a strategic approach for ETGBD that utilizes a four-step classification system and the optional use of 'Three-pillar' assistance with the following devices: cholangioscopy (SpyGlass DS, SG), a flex-type guidewire (Flex-GW), and a 3-Fr microcatheter (3-Fr Micro). METHODS A total of 115 patients undergoing ETGBD were studied retrospectively. Characteristics and technical outcomes were compared between conventional ETGBD technique (Classical ETGBD, N = 50) and strategic ETGBD with optional Three-pillar assistance (Strategic ETGBD, N = 65). RESULTS SG-assistance (15/65, 23.1%) was as an excellent troubleshooter in Category 1 (failure to identify the cystic duct [CD] orifice) and Category 2 (failure to advance the GW across the CD takeoff due to unfavorable angle). Flex-GW (19/65, 29.2%) worked for Category 3b (failure of GW access to the GB due to multiple tortuosities). 3-Fr Micro (11/65, 16.9%) was effective for Category 3a (failure of GW access to the GB due to CD obstruction) and Category 4 (failure of drainage stent insertion to the GB). The overall technical success rate was significantly higher for Strategic ETGBD (63/65, 96.9%) compared with Classical ETGBD (36/50, 72.0%) (p = 0.0001). CONCLUSIONS Strategic ETGBD, which includes the Three-pillar assistance options of SG in the initial steps, Flex-GW for tortuous CD, and 3-Fr Micro for stenotic CD, achieved a significantly higher success rate than for Classical ETGBD.
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Affiliation(s)
- Michihiro Yoshida
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Itaru Naitoh
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
- * E-mail:
| | - Kazuki Hayashi
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yasuki Hori
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Akihisa Kato
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kenta Kachi
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Go Asano
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hidenori Sahashi
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tadashi Toyohara
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kayoko Kuno
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yusuke Kito
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiromi Kataoka
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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10
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Sato J, Nakahara K, Michikawa Y, Suetani K, Igarashi Y, Sekine A, Satta Y, Kobayashi S, Otsubo T, Tateishi K. Long-term outcomes of endoscopic transpapillary gallbladder drainage using a novel spiral plastic stent in acute calculus cholecystitis. BMC Gastroenterol 2022; 22:539. [PMID: 36564715 PMCID: PMC9784005 DOI: 10.1186/s12876-022-02610-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Endoscopic transpapillary gallbladder stenting (EGBS) is considered for patients with contraindications to early surgery for acute calculus cholecystitis. However, evidence regarding the long-term outcomes of EGBS is insufficient to date. The aim of the study was to evaluate the feasibility of EGBS as a bridge to or alternative to surgery when there are contraindications. METHODS We reviewed the cases of patients who underwent EGBS using a novel spiral-shaped plastic stent for acute calculus cholecystitis between January 2011 and December 2019. We retrospectively evaluated the long-term outcomes of EGBS using a novel spiral-shaped plastic stent. RESULTS Forty-nine patients were included. The clinical success rate of EGBS was 97%. After EGBS, 25 patients (surgery group) underwent elective cholecystectomy and 24 patients did not (follow-up group). In the surgery group, the median period from EGBS to surgery was 93 days. There was a single late adverse event with cholecystitis recurrence. In the follow-up group, the median follow-up period was 236 days. Late adverse events were observed in eight patients, including recurrence of cholecystitis (four patients), duodenal penetration by the distal stent end (two patients), and distal stent migration (two patient). In the follow-up group, the time to recurrence of biliary obstruction was 527 days. CONCLUSIONS EGBS with a novel spiral-shaped plastic stent is safe and effective for long-term acute calculus cholecystitis. There is a possibility of EGBS to be a bridge to surgery and a surgical alternative for acute calculus cholecystitis in patients with contraindications to early cholecystectomy.
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Affiliation(s)
- Junya Sato
- grid.412764.20000 0004 0372 3116Department of Gastroenterology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa Japan
| | - Kazunari Nakahara
- grid.412764.20000 0004 0372 3116Department of Gastroenterology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa Japan
| | - Yosuke Michikawa
- grid.412764.20000 0004 0372 3116Department of Gastroenterology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa Japan
| | - Keigo Suetani
- grid.412764.20000 0004 0372 3116Department of Gastroenterology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa Japan
| | - Yosuke Igarashi
- grid.412764.20000 0004 0372 3116Department of Gastroenterology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa Japan
| | - Akihiro Sekine
- grid.412764.20000 0004 0372 3116Department of Gastroenterology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa Japan
| | - Yusuke Satta
- grid.412764.20000 0004 0372 3116Department of Gastroenterology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa Japan
| | - Shinjiro Kobayashi
- grid.412764.20000 0004 0372 3116Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa Japan
| | - Takehito Otsubo
- grid.412764.20000 0004 0372 3116Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa Japan
| | - Keisuke Tateishi
- grid.412764.20000 0004 0372 3116Department of Gastroenterology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa Japan
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11
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Abstract
Endoscopic drainage of the gallbladder for acute cholecystitis can be performed with the transpapillary method or endoscopic ultrasound (EUS)-guided method. EUS-guided gallbladder drainage (EUS-GBD) is gaining popularity as the treatment of choice for acute cholecystitis in patients who are deemed high-risk for cholecystectomy (CCY). It provides an alternative to percutaneous drainage and laparoscopic CCY in these patients. With the development of lumen-apposing metal stents (LAMS), the procedure is associated with high rates of technical and clinical success with low rates of adverse events (AEs). The aim of this article is to provide an overview of the current status of EUS-GBD including the indications, techniques, stent systems in-use, and how the procedure compares to conventional techniques are outlined. Furthermore, the feasibility of cholecystoscopy and advanced gallbladder interventions is explored. Finally, a comparison in outcomes of EUS-GBD versus laparoscopic CCY is provided giving some initial data in support of the procedure as an alternative to surgery in a selected group of patients.
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Affiliation(s)
- Xiaobei Luo
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Reem Sharaiha
- Division of Gastroenterology and Hepatology, New York Presbyterian Hospital/Weill Cornell Medical Centre, New York, NY, USA
| | - Anthony Yuen Bun Teoh
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
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12
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Park SW, Lee SS. Current status of endoscopic management of cholecystitis. Dig Endosc 2022; 34:439-450. [PMID: 34275173 DOI: 10.1111/den.14083] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 07/05/2021] [Accepted: 07/15/2021] [Indexed: 12/13/2022]
Abstract
Laparoscopic cholecystectomy remains the standard treatment for acute cholecystitis (AC) although it is always not suitable for patients who are poor candidates for surgery. Recently, endoscopic gallbladder (GB) drainage was found to be a potentially revolutionary alternative for cholecystectomy for the control of symptoms, definitive treatment, or bridging therapy until surgery is possible. Two endoscopic methods have been established using either the trans-mural or trans-papillary drainage approach. Endoscopic ultrasound-guided GB drainage (EUS-GBD; trans-mural approach) is a novel technique that allows stent placement between the GB and duodenum or stomach via fistula track, effectively enabling GB drainage. For endoscopic trans-papillary GB drainage (ETGBD; trans-papillary approach), attempts of selective cannulation to the cystic duct should be made to place the stent in the same manner as an endoscopic retrograde cholangiopancreatography. In comparison, EUS-GBD has higher clinical success and lower recurrence rates than ETGBD due to the use of larger-caliber stents, which allow for effective drainage when performed by skilled practitioners at high-volume centers. Advantages of ETGBD over EUS-GBD include more affordable costs and physiologic drainage, which preserves naive anatomy for possible future cholecystectomy. Although the field of endoscopic treatment for AC is rapidly advancing, important questions regarding which method improves clinical outcomes and safety more effectively remain unaddressed. Herein, the current status of endoscopic treatment for AC, including a technical review on clinical outcomes, adverse events, and advantages and disadvantages of each technique are reviewed, as well as other future prospects.
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Affiliation(s)
- Se Woo Park
- Division of Gastroenterology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong-si, Korea
| | - Sang Soo Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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13
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Inoue T, Yoshida M, Suzuki Y, Kitano R, Okumura F, Naitoh I. Long-Term Outcomes of Endoscopic Gallbladder Drainage for Cholecystitis in Poor Surgical Candidates: An Updated Comprehensive Review. J Clin Med 2021; 10:jcm10214842. [PMID: 34768361 PMCID: PMC8584655 DOI: 10.3390/jcm10214842] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 12/22/2022] Open
Abstract
Laparoscopic cholecystectomy is the standard and fundamental treatment of choice for acute cholecystitis; however, there are cases in which patients may be poor surgical candidates due to advanced age, comorbidities, and/or general condition. The rate of recurrent cholecystitis is high in patients who are not surgically treated; therefore, the prevention of recurrence in this patient population is an important subject of investigation in the management of cholecystitis. Although it has recently been reported that long-term stent placement by endoscopic gallbladder stenting or endoscopic ultrasound-guided gallbladder drainage may reduce the recurrence rate, its efficacy and safety remain controversial. Additionally, details surrounding the long-term stent management of these treatment methods should be further investigated. In this review, we summarize the updated evidence regarding the usefulness of long-term stent placement with endoscopic gallbladder stenting or endoscopic ultrasound-guided gallbladder drainage as a preventive measure for recurrence of cholecystitis and discuss issues that should be addressed in future studies.
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Affiliation(s)
- Tadahisa Inoue
- Department of Gastroenterology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute 480-1195, Japan;
- Correspondence: ; Tel.: +81-561-62-3311; Fax: +81-561-63-3208
| | - Michihiro Yoshida
- Department of Gastroenterology and Metabolism, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan; (M.Y.); (I.N.)
| | - Yuta Suzuki
- Department of Gastroenterology, Gifu Prefectural Tajimi Hospital, 5-161 Maehata-cho, Tajimi 507-8522, Japan; (Y.S.); (F.O.)
| | - Rena Kitano
- Department of Gastroenterology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute 480-1195, Japan;
| | - Fumihiro Okumura
- Department of Gastroenterology, Gifu Prefectural Tajimi Hospital, 5-161 Maehata-cho, Tajimi 507-8522, Japan; (Y.S.); (F.O.)
| | - Itaru Naitoh
- Department of Gastroenterology and Metabolism, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan; (M.Y.); (I.N.)
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14
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AbiMansour J, Law R. Transpapillary Gallbladder Drainage for Acute Cholecystitis: Two Stents or Not Two Stents. Clin Endosc 2021; 54:783-784. [PMID: 34645083 PMCID: PMC8652161 DOI: 10.5946/ce.2021.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 08/07/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Jad AbiMansour
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Ryan Law
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
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15
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Saumoy M, Yang J, Bhatt A, Bucobo JC, Chandrasekhara V, Copland AP, Krishnan K, Kumta NA, Law RJ, Pannala R, Parsi MA, Rahimi EF, Trikudanathan G, Trindade AJ, Lichtenstein DR. Endoscopic therapies for gallbladder drainage. Gastrointest Endosc 2021; 94:671-684. [PMID: 34344541 DOI: 10.1016/j.gie.2021.05.031] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 05/21/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Endoscopic management of acute cholecystitis has expanded in patients who are considered nonoperative candidates. Traditionally managed with percutaneous cholecystostomy (PC), improvement in techniques and devices has led to increased use of endoscopic methods for gallbladder drainage. This document reviews technical aspects of endoscopic transpapillary gallbladder drainage (ET-GBD) and EUS-guided GBD (EUS-GBD) as well as their respective technical/clinical success and adverse event rates. Available comparative data are also reviewed among nonsurgical gallbladder drainage techniques (PC, ET-GBD, and EUS-GBD). METHODS The MEDLINE database was searched through March 2021 for relevant articles by using keywords including "acute cholecystitis," "interventional EUS," "percutaneous cholecystostomy," "transpapillary gallbladder drainage," "EUS-guided gallbladder drainage," "lumen-apposing metal stent," "gallbladder stenting," and "endoscopic gallbladder drainage." The manuscript was drafted by 2 authors and reviewed by members of the American Society for Gastrointestinal Endoscopy Technology Committee and subsequently by the American Society for Gastrointestinal Endoscopy Governing Board. RESULTS Multiple studies have demonstrated acceptable outcomes comparing PC and both endoscopic gallbladder drainage techniques, ET-GBD and EUS-GBD. Published data suggest that endoscopic gallbladder drainage techniques may be associated with lower rates of adverse events and improved quality of life. However, there are important clinical considerations for choosing among these treatment options, requiring a multidisciplinary and collaborative approach to therapeutic decision-making in these patients. CONCLUSIONS The implementation of EUS-GBD and ET-GBD in high-risk surgical patients with acute cholecystitis may result in favorable outcomes when compared with PC. Further improvements in techniques and training should lead to more widespread acceptance and dissemination of these treatment options.
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Affiliation(s)
- Monica Saumoy
- Department of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Julie Yang
- Division of Gastroenterology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Amit Bhatt
- Department of Gastroenterology, Hepatology & Nutrition, Cleveland Clinic, Cleveland, Ohio, USA
| | - Juan Carlos Bucobo
- Division of Gastroenterology and Hepatology, Stony Brook Medicine, Stony Brook, New York, USA
| | - Vinay Chandrasekhara
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew P Copland
- Division of Gastroenterology and Hepatology, University of Virginia Health Systems, Charlottesville, Virginia, USA
| | - Kumar Krishnan
- Division of Gastroenterology, Department of Internal Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nikhil A Kumta
- Division of Gastroenterology, Mount Sinai Hospital, New York, New York, USA
| | - Ryan J Law
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Rahul Pannala
- Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Mansour A Parsi
- Section for Gastroenterology and Hepatology, Tulane University Health Sciences Center, New Orleans, Louisiana, USA
| | - Erik F Rahimi
- Department of Gastroenterology, Baylor Scott & White Health, Lakeway, Texas, USA
| | - Guru Trikudanathan
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA
| | - Arvind J Trindade
- Department of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, New Hyde Park, New York, USA
| | - David R Lichtenstein
- Division of Gastroenterology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
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16
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Jandura DM, Puli SR. Efficacy and safety of endoscopic transpapillary gallbladder drainage in acute cholecystitis: An updated meta-analysis. World J Gastrointest Endosc 2021; 13:345-355. [PMID: 34512882 PMCID: PMC8394187 DOI: 10.4253/wjge.v13.i8.345] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/21/2021] [Accepted: 07/05/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Percutaneous transhepatic gallbladder drainage has been the most frequently performed treatment for acute cholecystitis for patients who are not candidates for surgery. Endoscopic transpapillary gallbladder drainage (ETGBD) has evolved into an alternative treatment. There have been numerous retrospective and prospective studies evaluating ETGBD for acute cholecystitis, though results have been variable.
AIM To evaluate the efficacy and safety of ETGBD in the treatment of inoperable patients with acute cholecystitis.
METHODS We performed a systematic review of major literature databases including PubMed, OVID, Science Direct, Google Scholar (from inception to March 2021) to identify studies reporting technical and clinical success, and post procedure adverse events in ETGBD. Weighted pooled rates were then calculated using fixed effects models for technical and clinical success, and post procedure adverse events, including recurrent cholecystitis.
RESULTS We found 21 relevant articles that were then included in the study. In all 1307 patients were identified. The pooled technical success rate was 82.62% [95% confidence interval (CI): 80.63-84.52]. The pooled clinical success rate was found to be 94.87% (95%CI: 93.54-96.05). The pooled overall complication rate was 8.83% (95%CI: 7.42-10.34). Pooled rates of post procedure adverse events were bleeding 1.03% (95%CI: 0.58-1.62), perforation 0.78% (95%CI: 0.39-1.29), peritonitis/bile leak 0.45% (95%CI: 0.17-0.87), and pancreatitis 1.98% (95%CI: 1.33-2.76). The pooled rates of stent occlusion and migration were 0.39% (95%CI: 0.13-0.78) and 1.3% (95%CI: 0.75-1.99) respectively. The pooled rate of cholecystitis recurrence following ETGBD was 1.48% (95%CI: 0.92-2.16).
CONCLUSION Our meta-analysis suggests that ETGBD is a feasible and efficacious treatment for inoperable patients with acute cholecystitis.
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Affiliation(s)
- David M Jandura
- Department of Gastroenterology, University of Illinois College of Medicine at Peoria, Peoria, IL 61637, United States
| | - Srinivas R Puli
- Department of Gastroenterology and Hepatology, University of Illinois College of Medicine at Peoria, Peoria, IL 61637, United States
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17
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Almuhaidb A, Olson D, Aadam AA. Advancements in Endoscopic Biliary Interventions by Gastroenterology. Semin Intervent Radiol 2021; 38:280-290. [PMID: 34393338 DOI: 10.1055/s-0041-1731266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is an endoscopic technique in which a specialized side-viewing endoscope is guided into the duodenum, allowing for instruments to access the biliary and pancreatic ducts. ERCP was initially developed as a diagnostic tool as computed tomography was in its infancy during that time. ERCP has evolved since its inception in the 1960s to becoming not only a valuable diagnostic resource but now an effective therapeutic intervention in the treatment of various biliary disorders. The most common biliary interventions performed by ERCP include the management of biliary obstructions for benign and malignant indications. Additionally, endoscopic ultrasound (EUS) has been increasingly utilized in diagnosing and intervening on pancreaticobiliary lesion. This article will discuss the various methods currently available for various endoscopic biliary interventions and future interventional techniques. For the management of biliary strictures, EUS can be utilized with fine need aspiration, while ERCP can be used for the placement of various stents and diagnostic modalities. Another example is radiofrequency ablation, which can be used for the treatment of hilar strictures. Achieving bile duct access can be challenging in patients with complicated clinical scenarios; other techniques that can be used for bile duct access include EUS-guided rendezvous approach, transluminal approach, Choleodochoduodenostomy, and hepatogastrostomy, along with gaining access in complicated anatomy such as in patients with Rou-en-Y anatomy. Another useful endoscopic tool is nonsurgical drainage of the gallbladder, which can be a suitable option when patients are not optimal surgical candidates. There has also been an increase in outpatient utilization of ERCP, which was previously seen as a predominantly inpatient procedure in the past. Possible future evolutions of biliary interventions include robotic manipulation of a duodenoscope and direct infusion of chemotherapeutic or immunomodulatory agents into the pancreaticobiliary tree. These advancements will depend on parallel advancements in other imaging and laboratory as well as breakthrough technology or techniques by other disciplines including interventional radiology and minimally invasive surgery.
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Affiliation(s)
- Aymen Almuhaidb
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Dylan Olson
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - A Aziz Aadam
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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18
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McCarty TR, Hathorn KE, Bazarbashi AN, Jajoo K, Ryou M, Thompson CC. Endoscopic gallbladder drainage for symptomatic gallbladder disease: a cumulative systematic review meta-analysis. Surg Endosc 2021; 35:4964-4985. [PMID: 34231061 DOI: 10.1007/s00464-020-07758-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 06/23/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Endoscopic ultrasound (EUS)-guided transmural or endoscopic retrograde cholangiography (ERC)-based transpapillary drainage may provide alternative treatment strategies for high-risk surgical candidates with symptomatic gallbladder (GB) disease. The primary aim of this study was to perform a systematic review and meta-analysis to investigate the efficacy and safety of endoscopic GB drainage for patients with symptomatic GB disease. METHODS Searches of PubMed, EMBASE, Web of Science, and Cochrane Library databases were performed in accordance with PRISMA and MOOSE guidelines. Pooled proportions were calculated for measured outcomes including technical success, clinical success, adverse event rate, recurrence rate, and rate of reintervention. Subgroup analyses were performed for transmural versus transpapillary, transmural lumen apposing stent (LAMS), and comparison to percutaneous transhepatic drainage. Heterogeneity was assessed with I2 statistics. Publication bias was ascertained by funnel plot and Egger regression testing. RESULTS Thirty-six studies (n = 1538) were included. Overall, endoscopic GB drainage achieved a technical and clinical success of 87.33% [(95% CI 84.42-89.77); I2 = 39.55] and 84.16% [(95% CI 80.30-87.38); I2 = 52.61], with an adverse event rate of 11.00% [(95% CI 9.25-13.03); I2 = 7.08]. On subgroup analyses, EUS-guided transmural compared to ERC-assisted transpapillary drainage resulted in higher technical and clinical success rates [OR 3.91 (95% CI 1.52-10.09); P = 0.005 and OR 4.59 (95% CI 1.84-11.46); P = 0.001] and lower recurrence rate [OR 0.17 (95% CI 0.06-0.52); P = 0.002]. Among EUS-guided LAMS studies, technical success was 94.65% [(95% CI 91.54-96.67); I2 = 0.00], clinical success was 92.06% [(95% CI 88.65-94.51); I2 = 0.00], and adverse event rate was 11.71% [(95% CI 8.92-15.23); I2 = 0.00]. Compared to percutaneous drainage, EUS-guided drainage possessed a similar efficacy and safety with significantly lower rate of reintervention [OR 0.05 (95% CI 0.02-0.13); P < 0.001]. DISCUSSION Endoscopic GB drainage is a safe and effective treatment for high-risk surgical candidates with symptomatic GB disease. EUS-guided transmural drainage is superior to transpapillary drainage and associated with a lower rate of reintervention compared to percutaneous transhepatic drainage.
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Affiliation(s)
- Thomas R McCarty
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, 02115, USA
| | - Kelly E Hathorn
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, 02115, USA
| | - Ahmad Najdat Bazarbashi
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, 02115, USA
| | - Kunal Jajoo
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, 02115, USA
| | - Marvin Ryou
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, 02115, USA
| | - Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA. .,Harvard Medical School, Boston, MA, 02115, USA.
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19
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Yoshida M, Naitoh I, Hayashi K, Jinno N, Hori Y, Natsume M, Kato A, Kachi K, Asano G, Atsuta N, Sahashi H, Kataoka H. Four-Step Classification of Endoscopic Transpapillary Gallbladder Drainage and the Practical Efficacy of Cholangioscopic Assistance. Gut Liver 2021; 15:476-485. [PMID: 33402544 PMCID: PMC8129659 DOI: 10.5009/gnl20238] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/05/2020] [Accepted: 09/17/2020] [Indexed: 12/22/2022] Open
Abstract
Background/Aims Although endoscopic transpapillary gallbladder drainage (ETGBD) has been reported as an alternative procedure for acute cholecystitis, it requires advanced endoscopic techniques. In terms of the certainty of achieving drainage, it remains a challenging procedure. The aim of the current study was to elucidate the practical efficacy of cholangioscopic assistance and to develop a new classification that could be used to evaluate the technical difficulty of ETGBD and provide a theoretical strategy to apply cholangioscopy appropriately for difficult ETGBD. Methods A total of 101 patients undergoing ETGBD were retrospectively studied. The characteristics and technical outcomes of ETGBD with conventional ETGBD (C-ETGBD) and SpyGlass DS-assisted ETGBD (SG-ETGBD) were evaluated. The characteristics and technique-dependent factors of unsuccessful C-ETGBD/SG-ETGBD were evaluated using the classification based on the steps of the procedure. The predictive factors of successful C-ETGBD/SG-ETGBD were examined. Results C-ETGBD was successful in 73 patients (72.3%). SG-ETGBD was successful in 11 of 13 patients (84.6%) who had C-ETGBD failure. Optional SG-ETGBD significantly increased the final success rate (94.1%) compared to C-ETGBD alone (p=0.003). ETGBD procedures could be classified into four steps. SG-assistance worked as an excellent troubleshooter in step 1 (failure to identify the cystic duct orifice) and step 2 (failure of guidewire advancement across the downturned angle of cystic duct takeoff). Magnetic resonance cholangiopancreatography could provide predictive information based on the classification. Conclusions Optional SG-ETGBD achieved a significantly higher success rate than C-ETGBD alone. Step classification is helpful for determining the technical difficulty of ETGBD and developing a theoretical strategy to apply cholangioscopy in a coordinated manner.
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Affiliation(s)
- Michihiro Yoshida
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Itaru Naitoh
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kazuki Hayashi
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Naruomi Jinno
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yasuki Hori
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Makoto Natsume
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Akihisa Kato
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kenta Kachi
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Go Asano
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Naoki Atsuta
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hidenori Sahashi
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiromi Kataoka
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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20
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Sun X, Liu Y, Hu Q, Zhao X, Li X, Wang Z. Endoscopic transpapillary gallbladder drainage for management of acute cholecystitis with coagulopathy. J Int Med Res 2021; 49:300060521996912. [PMID: 33706610 PMCID: PMC8168036 DOI: 10.1177/0300060521996912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
Acute cholecystitis is a common and frequently occurring disease, and laparoscopic cholecystectomy is the preferred treatment method. Percutaneous transhepatic gallbladder drainage is regarded as the first-line palliative procedure for elderly patients with poor cardiopulmonary function who cannot tolerate general anesthesia. However, for patients with acute cholecystitis who are undergoing treatment with oral antithrombotics or who have abnormal coagulation mechanisms, endoscopic transpapillary gallbladder drainage may be a good choice. Endoscopic transpapillary gallbladder drainage is an endoscopic retrograde cholangiopancreatography-based technique that drains the gallbladder by placing a tube into the cavity of the gallbladder though the cystic gall duct. It is the application of the concept of natural orifice transluminal endoscopic surgery in the biliary system. This technique can not only achieve gallbladder drainage but can also minimize the risk of procedure-induced bleeding. In this paper, we describe a representative case to introduce the key points of this procedure and the associated clinical care, hoping to provide useful information for clinicians and nurses.
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Affiliation(s)
- Xiaoping Sun
- Health Management Center, Lanzhou University Second Hospital, Lanzhou, Gansu, China.,Endoscopic Center, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Yiting Liu
- Health Management Center, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Qing Hu
- Health Management Center, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Xuyang Zhao
- Endoscopic Center, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Xingjie Li
- Health Management Center, Lanzhou University Second Hospital, Lanzhou, Gansu, China.,Endoscopic Center, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Zhiping Wang
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, Gansu, China
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21
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Sobani ZA, Ling C, Rustagi T. Endoscopic Transpapillary Gallbladder Drainage for Acute Cholecystitis. Dig Dis Sci 2021; 66:1425-1435. [PMID: 32588249 DOI: 10.1007/s10620-020-06422-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 06/14/2020] [Indexed: 02/06/2023]
Abstract
The mainstay of management of acute cholecystitis has been surgical, with percutaneous gallbladder drainage in patients deemed high risk for surgical intervention. Endoscopic management of acute cholecytitis with transpapillary and transmural drainage of the gall bladder is emerging as a viable alternative in high-risk surgical patients. In this article, we discuss the background, current status, technical challenges and strategies to overcome them, adverse events, and outcomes of endoscopic transpapillary gallbladder drainage for management of acute cholecystitis.
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Affiliation(s)
- Zain A Sobani
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of New Mexico, MSC10 5550, 1 University of New Mexico, Albuquerque, NM, 87131, USA
| | - Christina Ling
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of New Mexico, MSC10 5550, 1 University of New Mexico, Albuquerque, NM, 87131, USA
| | - Tarun Rustagi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of New Mexico, MSC10 5550, 1 University of New Mexico, Albuquerque, NM, 87131, USA.
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22
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Sagami R, Hayasaka K, Ujihara T, Nakahara R, Murakami D, Iwaki T, Suehiro S, Katsuyama Y, Harada H, Nishikiori H, Murakami K, Amano Y. Endoscopic transpapillary gallbladder drainage for acute cholecystitis is feasible for patients receiving antithrombotic therapy. Dig Endosc 2020; 32:1092-1099. [PMID: 32052507 DOI: 10.1111/den.13650] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 02/06/2020] [Accepted: 02/09/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Patients with acute cholecystitis receiving antithrombotic therapy (ATT) have an increased risk of bleeding complications during surgery and percutaneous drainage. Endoscopic transpapillary gallbladder drainage (ETGBD) is recommended for such cases; however, evidence is limited. To investigate this issue further, we performed a retrospective multicenter study. METHODS One hundred thirty patients with acute cholecystitis who underwent ETGBD were enrolled. They were divided into an ATT group (continuation of ATT on the day of the procedure and/or heparin substitution) and a Non-ATT group (discontinuation or no use of ATT). The primary outcome was bleeding complication rate, and the secondary outcomes were technical success rate, clinical success rate and total complication rate. RESULTS Eighty-three patients were enrolled in the ATT group, and 47 were enrolled in the Non-ATT group. In the ATT group, 42.2% continued multi-agent ATT. No bleeding complications occurred in either group. There were no significant differences between the ATT and Non-ATT groups in the technical success rate (84.3% vs 89.4%, P = 0.426 respectively) or the clinical success rate (97.1% vs 100%, P = 0.259, respectively). The overall early complication rate was 3.1% (4/130): mild pancreatitis (n = 3) and cholangitis (n = 1). Stent dysfunction was found in 10.9% of patients (at 196 days on average), and the 12-month stent patency rate was 69.0%. CONCLUSIONS No significant difference was found in the bleeding complication rate between ETGBD with and without ATT. ETGBD may be an ideal drainage method for patients with acute cholecystitis receiving ATT.
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Affiliation(s)
- Ryota Sagami
- Departments of, Department of, Gastroenterology, New Tokyo Hospital, Chiba, Japan
| | - Kenji Hayasaka
- Departments of, Department of, Gastroenterology, New Tokyo Hospital, Chiba, Japan
| | - Tetsuro Ujihara
- Departments of, Department of, Gastroenterology, New Tokyo Hospital, Chiba, Japan
| | - Ryotaro Nakahara
- Departments of, Department of, Gastroenterology, New Tokyo Hospital, Chiba, Japan
| | - Daisuke Murakami
- Departments of, Department of, Gastroenterology, New Tokyo Hospital, Chiba, Japan
| | - Tomoyuki Iwaki
- Departments of, Department of, Gastroenterology, New Tokyo Hospital, Chiba, Japan
| | - Satoshi Suehiro
- Departments of, Department of, Gastroenterology, New Tokyo Hospital, Chiba, Japan
| | - Yasushi Katsuyama
- Departments of, Department of, Gastroenterology, New Tokyo Hospital, Chiba, Japan
| | - Hideaki Harada
- Departments of, Department of, Gastroenterology, New Tokyo Hospital, Chiba, Japan
| | | | - Kazunari Murakami
- Department of Gastroenterology, Faculty of Medicine, Oita University, Oita, Japan
| | - Yuji Amano
- Department of, Endoscopy, New Tokyo Hospital, Chiba, Japan
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23
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Arvanitakis M. Endoscopic transpapillary gallbladder stent placement for high-risk patients with cholecystitis: an oldie but still a goodie. Gastrointest Endosc 2020; 92:645-647. [PMID: 32838911 DOI: 10.1016/j.gie.2020.04.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 04/19/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Marianna Arvanitakis
- Department of Gastroenterology, Hepato-Pancreatology, and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
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24
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Single-operator peroral cholangioscopy cystic duct cannulation for transpapillary gallbladder stent placement in patients with acute cholecystitis at moderate to high surgical risk (with videos). Gastrointest Endosc 2020; 92:634-644. [PMID: 32330504 DOI: 10.1016/j.gie.2020.03.3866] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 03/01/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS One of the main reasons for failed endoscopic transpapillary gallbladder stenting (ETGS) under fluoroscopic guidance is the inability to cannulate the cystic duct. Single-operator peroral cholangioscopy (SOC)-assisted ETGS is an adjunct technique to facilitate ETGS. We aimed to demonstrate its efficacy. METHODS Between 2015 and 2019, 104 patients with acute cholecystitis at moderate to high surgical risk underwent ETGS, which involved 3 steps: (1) cystic duct cannulation under fluoroscopic guidance with or without additional SOC guidance; (2) guidewire placement; and (3) stent placement in the gallbladder. The technical success rate was determined when stent placement was confirmed endoscopically and radiographically. RESULTS Of 104 patients, 55 (53%) patients had successful ETGS under fluoroscopic guidance. Of 49 patients who had failed fluoroscopy-guided ETGS, 41 patients underwent additional SOC-assisted ETGS and 5 patients proceeded to other interventions. Of patients who underwent SOC-assisted ETGS (n = 41), 23 (56%) cystic cannulation followed by stent placement were successful; cystic duct cannulations, guidewire, and stent placement failed in 8, 9, and 1 patients, respectively. The overall technical success rate of ETGS increased from 53% (55 of 104) to 75% (78 of 104) after additional SOC assistance. Adverse events and recurrence were not different between patients who underwent ETGS under fluoroscopic guidance and those who underwent SOC-assisted ETGS. CONCLUSIONS In patients with acute cholecystitis who are not surgical candidates, SOC-assisted ETGS can increase the technical success rate after failed fluoroscopic guidance. SOC can help for the cystic duct cannulation and guidewire placement steps but not for the stent placement step.
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25
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Tanaka K, Katanuma A, Hayashi T, Kin T, Takahashi K. Role of endoscopic ultrasound for gallbladder disease. J Med Ultrason (2001) 2020; 48:187-198. [PMID: 32661803 PMCID: PMC8079297 DOI: 10.1007/s10396-020-01030-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/18/2020] [Indexed: 12/15/2022]
Abstract
Endoscopic ultrasonography (EUS) has excellent spatial resolution and allows more detailed examination than abdominal ultrasonography (US) in terms of qualitative diagnosis of tumors and evaluation of tumor invasion depth. To understand the role of EUS in gallbladder disease, we need to understand the normal gallbladder wall structure and how to visualize it on EUS. In addition, gallbladder lesions can be classified into two broad categories: protuberant and wall-thickening lesions. Here, the features on EUS were outlined. We also outlined the current status of EUS-FNA for gallbladder lesions as there have been scattered reports of EUS-FNA in recent years.
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Affiliation(s)
- Kazunari Tanaka
- Center for Gastroenterology, Teine Keijinkai Hospital, 1-40-1-12 Maeda, Teine-ku, Sapporo, 006-8555, Japan.
| | - Akio Katanuma
- Center for Gastroenterology, Teine Keijinkai Hospital, 1-40-1-12 Maeda, Teine-ku, Sapporo, 006-8555, Japan
| | - Tsuyoshi Hayashi
- Center for Gastroenterology, Teine Keijinkai Hospital, 1-40-1-12 Maeda, Teine-ku, Sapporo, 006-8555, Japan
| | - Toshifumi Kin
- Center for Gastroenterology, Teine Keijinkai Hospital, 1-40-1-12 Maeda, Teine-ku, Sapporo, 006-8555, Japan
| | - Kuniyuki Takahashi
- Center for Gastroenterology, Teine Keijinkai Hospital, 1-40-1-12 Maeda, Teine-ku, Sapporo, 006-8555, Japan
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26
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Gulati R, Rustagi T. Bouncing off the balloon: A new trick for selective cystic duct cannulation. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2020; 28:e8-e10. [PMID: 32372502 DOI: 10.1002/jhbp.752] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 04/05/2020] [Accepted: 04/11/2020] [Indexed: 11/08/2022]
Abstract
Selective cannulation of the cystic duct for endoscopic transpapillary gallbladder drainage can be challenging in cases with a caudally branching cystic duct. Gulati and Rustagi describe a novel and simple technique in which a guidewire is bounced off a stone extraction balloon and redirected into the cystic duct.
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Affiliation(s)
- Rishabh Gulati
- Division of Gastroenterology and Hepatology, University of New Mexico, Albuquerque, NM, USA
| | - Tarun Rustagi
- Division of Gastroenterology and Hepatology, University of New Mexico, Albuquerque, NM, USA
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27
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Maruta A, Iwata K, Iwashita T, Yoshida K, Ando N, Toda K, Mukai T, Shimizu M. Factors affecting technical success of endoscopic transpapillary gallbladder drainage for acute cholecystitis. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2020; 27:429-436. [DOI: 10.1002/jhbp.744] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/10/2020] [Accepted: 03/23/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Akinori Maruta
- Department of Gastroenterology Gifu Prefectural General Medical Center Gifu Japan
| | - Keisuke Iwata
- Department of Gastroenterology Gifu Prefectural General Medical Center Gifu Japan
| | - Takuji Iwashita
- First Department of Internal Medicine Gifu University Hospital Gifu Japan
| | - Kensaku Yoshida
- Department of Gastroenterology Gifu Prefectural General Medical Center Gifu Japan
| | - Nobuhiro Ando
- Department of Gastroenterology Gifu Prefectural General Medical Center Gifu Japan
| | - Katsuhisa Toda
- Department of Gastroenterology Gifu Chuno Kosei Hospital Gifu Japan
| | - Tsuyoshi Mukai
- Department of Gastroenterology Gifu Municipal Hospital Gifu Japan
| | - Masahito Shimizu
- First Department of Internal Medicine Gifu University Hospital Gifu Japan
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28
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Torres Yuste R, Garcia-Alonso FJ, Sanchez-Ocana R, Cimavilla Roman M, Peñas Herrero I, Carbajo AY, De Benito Sanz M, Mora Cuadrado N, De la Serna Higuera C, Perez-Miranda M. Safety and efficacy of endoscopic ultrasound-guided gallbladder drainage combined with endoscopic retrograde cholangiopancreatography in the same session. Dig Endosc 2020; 32:608-615. [PMID: 31608503 DOI: 10.1111/den.13562] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 10/09/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is an emerging option for acute cholecystitis in non-surgical candidates. Combining endoscopic retrograde cholangiopancreatography (ERCP) for common bile duct stones with EUS-GBD in a single session might become a non-surgical management strategy to comprehensively treat gallstone disease in selected patients. METHODS Single-center retrospective cohort study comparing outcomes between EUS-GBD alone (group A) and single-session ERCP combined with EUS-GBD (group B). Consecutive patients who underwent EUS-GBD with a lumen-apposing metal stent (LAMS) between June 2011 and August 2018 were analyzed. Exclusion criteria were subjects included in randomized clinical trials, patients who had had ERCP within 5 days of EUS-GBD, patients in whom ERCP or EUS-GBD was carried out for salvage of one or the other procedure, and patients who underwent concurrent EUS-guided biliary drainage. RESULTS One hundred and nine consecutive patients underwent EUS-GBD with LAMS during the study period. Seventy-one patients satisfied the inclusion criteria and 34 patients were in group A and 37 in group B. Baseline characteristics were similar in both groups. There were no significant differences in technical (97.1% vs 97.3%; P = 0.19) and clinical success rates (88.2% vs 94.6%; P = 0.42) of EUS-GBD in group A versus group B. Rate of adverse events was similar in both groups, five (14.7%) in group A versus five (13.5%) in group B. CONCLUSIONS Single-session EUS-GBD combined with ERCP has comparable rates of technical and clinical success to EUS-GBD alone. A combined EUS-GBD and ERCP procedure does not appear to increase adverse events and makes possible comprehensive treatment of gallstone disease by purely endoscopic means.
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Affiliation(s)
- Raul Torres Yuste
- Gastroenterology Department, University Hospital Rio Hortega, Valladolid, Spain
| | | | - Ramón Sanchez-Ocana
- Gastroenterology Department, University Hospital Rio Hortega, Valladolid, Spain
| | | | - Irene Peñas Herrero
- Gastroenterology Department, University Hospital Rio Hortega, Valladolid, Spain
| | - Ana Yaiza Carbajo
- Gastroenterology Department, University Hospital Rio Hortega, Valladolid, Spain
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29
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Sagami R, Hayasaka K, Nishikiori H, Harada H, Amano Y. Current Status in the Treatment of Acute Cholecystitis Patients Receiving Antithrombotic Therapy: Is Endoscopic Drainage Feasible?- A Systematic Review. Clin Endosc 2020; 53:176-188. [PMID: 31914723 PMCID: PMC7137572 DOI: 10.5946/ce.2019.177] [Citation(s) in RCA: 10] [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: 09/09/2019] [Accepted: 10/12/2019] [Indexed: 12/15/2022] Open
Abstract
The bleeding complication risk of surgery or percutaneous transhepatic gallbladder drainage (PTGBD) may increase in patients with acute cholecystitis receiving antithrombotic therapy (ATT). Endoscopic gallbladder drainage (EGBD) may be recommended for such patients. English articles published between 1991 and 2018 in peer-reviewed journals that discuss cholecystectomy, PTGBD, and EGBD in patients with ATT or coagulopathy were reviewed to assess the safety of the procedures, especially in terms of the bleeding complication. There were 8 studies on cholecystectomy, 3 on PTGBD, and 1 on endoscopic transpapillary gallbladder drainage (ETGBD) in patients receiving ATT. With respect to EGBD, 28 studies on ETGBD (including 1 study already mentioned above) and 26 studies on endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) were also analyzed. The overall bleeding complication rate in patients with ATT who underwent cholecystectomy was significantly higher than that in patients without ATT (6.5% [23/354] vs. 1.2% [26/2,224], p<0.001). However, the bleeding risk of cholecystectomy and PTGBD in patients receiving ATT was controversial. The overall technical success, clinical success, and bleeding complication rates of ETGBD vs. EUS-GBD were 84% vs. 96% (p<0.001), 92% vs. 97% (p<0.001), and 0.65% vs. 2.1% (p=0.005), respectively. One patient treated with ETGBD experienced bleeding complication among 191 patients with bleeding tendency. ETGBD may be an ideal drainage procedure for patients receiving ATT from the viewpoint of bleeding, although EUS-GBD is also efficacious.
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Affiliation(s)
- Ryota Sagami
- Department of Gastroenterology, New Tokyo Hospital, Chiba, Japan
| | - Kenji Hayasaka
- Department of Gastroenterology, New Tokyo Hospital, Chiba, Japan
| | | | - Hideaki Harada
- Department of Gastroenterology, New Tokyo Hospital, Chiba, Japan
| | - Yuji Amano
- Department of Endoscopy, New Tokyo Hospital, Chiba, Japan
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30
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James TW, Baron TH. EUS-guided gallbladder drainage: A review of current practices and procedures. Endosc Ultrasound 2019; 8:S28-S34. [PMID: 31897376 PMCID: PMC6896434 DOI: 10.4103/eus.eus_41_19] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 06/18/2019] [Indexed: 12/18/2022] Open
Abstract
EUS-guided gallbladder drainage (EUS-GBD) is utilized for the treatment of acute cholecystitis and symptomatic cholelithiasis in patients who are poor operative candidates. Over the last several years, improved techniques and accessories have facilitated GBD. Recent literature demonstrated effectiveness and safety of EUS-guided GBD. Available data suggest at least similar results when compared to percutaneous cholecystostomy. EUS-guided GBD can be performed as a primary intervention in patients with cholecystitis who are unfit for urgent surgical intervention and as a secondary intervention to internalize biliary drainage in patients with indwelling percutaneous cholecystostomy catheters. Various stents can be used for -EUS-guided GBD. The optimal device and technique have yet to be determined, although at the present time, the use of luminal apposing stents is preferred. The purpose of this review is to provide the highlights of the most recent literature on EUS-guided GBD.
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Affiliation(s)
- Theodore W James
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA
| | - Todd Huntley Baron
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA
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31
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Sagami R, Hayasaka K, Ujihara T, Nakahara R, Murakami D, Iwaki T, Suehiro S, Katsuyama Y, Harada H, Amano Y. A New Technique of Endoscopic Transpapillary Gallbladder Drainage Combined with Intraductal Ultrasonography for the Treatment of Acute Cholecystitis. Clin Endosc 2019; 53:221-229. [PMID: 31684701 PMCID: PMC7137567 DOI: 10.5946/ce.2019.099] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 07/24/2019] [Indexed: 12/24/2022] Open
Abstract
Background/Aims: Endoscopic transpapillary gallbladder drainage (ETGBD) is useful for the treatment of acute cholecystitis; however, the technique is difficult to perform. When intraductal ultrasonography (IDUS) is combined with ETGBD, the orifice of the cystic duct in the common bile duct may be more easily detected in the cannulation procedure. The aim of this study was to evaluate the efficacy of ETGBD with IDUS compared with that of ETGBD alone.
Methods: A total of 100 consecutive patients with acute cholecystitis requiring ETGBD were retrospectively recruited. The first 50 consecutive patients were treated using ETGBD without IDUS, and the next 50 patients were treated using ETGBD with IDUS. Through propensity score matching analysis, we compared the clinical outcomes between the groups. The primary outcome was the technical success rate.
Results: The technical success rate of ETGBD with IDUS was significantly higher than that of ETGBD without IDUS (92.0% vs. 76.0%, p=0.044). There was no significant difference in procedure length between the two groups (74.0 min vs. 66.7 min, p=0.310). The complication rate of ETGBD with IDUS was significantly higher than that of ETGBD without IDUS (6.0% vs. 0%, p<0.001); however, only one case showed an IDUS technique-related complication (pancreatitis).
Conclusions: The assistance of IDUS may be useful in ETGBD.
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Affiliation(s)
- Ryota Sagami
- Department of Gastroenterology, New Tokyo Hospital, Chiba, Japan
| | - Kenji Hayasaka
- Department of Gastroenterology, New Tokyo Hospital, Chiba, Japan
| | - Tetsuro Ujihara
- Department of Gastroenterology, New Tokyo Hospital, Chiba, Japan
| | - Ryotaro Nakahara
- Department of Gastroenterology, New Tokyo Hospital, Chiba, Japan
| | - Daisuke Murakami
- Department of Gastroenterology, New Tokyo Hospital, Chiba, Japan
| | - Tomoyuki Iwaki
- Department of Gastroenterology, New Tokyo Hospital, Chiba, Japan
| | - Satoshi Suehiro
- Department of Gastroenterology, New Tokyo Hospital, Chiba, Japan
| | | | - Hideaki Harada
- Department of Gastroenterology, New Tokyo Hospital, Chiba, Japan
| | - Yuji Amano
- Department of Endoscopy, New Tokyo Hospital, Chiba, Japan
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Kim TH, Bae HJ, Hong SG. A Rare Fatal Bile Peritonitis after Malposition of Endoscopic Ultrasound-Guided 5-Fr Naso-Gallbladder Drainage. Clin Endosc 2019; 53:97-100. [PMID: 31476845 PMCID: PMC7003009 DOI: 10.5946/ce.2019.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 05/24/2019] [Indexed: 12/15/2022] Open
Abstract
Endoscopic ultrasound (EUS)-guided gallbladder (GB) drainage has recently emerged as a more feasible treatment than percutaneous transhepatic GB drainage for acute cholecystitis. In EUS-guided cholecystostomies in patients with distended GBs without pericholecystic inflammation or prominent wall thickening, a needle puncture with tract dilatation is often difficult. Guidewires may slip during the insertion of thin and flexible drainage catheters, which can also cause the body portion of the catheter to be unexpectedly situated and prolonged between the GB and intestines because the non-inflamed distended GB is fluctuant. Upon fluoroscopic examination during the procedure, the position of the abnormally coiled catheter may appear to be correct in patients with a distended stomach. We experienced such an adverse event with fatal bile peritonitis in a patient with GB distension suggestive of malignant bile duct stricture. Fatal bile peritonitis then occurred. Therefore, the endoscopist should confirm the indications for cholecystostomy and determine whether a distended GB is a secondary change or acute cholecystitis.
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Affiliation(s)
- Tae Hyung Kim
- Department of Internal Medicine, SAM Anyang Hospital, Anyang, Korea
| | - Hyun Jin Bae
- Department of Internal Medicine, SAM Anyang Hospital, Anyang, Korea
| | - Seung Goun Hong
- Department of Internal Medicine, SAM Anyang Hospital, Anyang, Korea
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Nakahara K, Michikawa Y, Morita R, Suetani K, Morita N, Sato J, Tsuji K, Ikeda H, Matsunaga K, Watanabe T, Matsumoto N, Kobayashi S, Otsubo T, Itoh F. Endoscopic transpapillary gallbladder stenting using a newly designed plastic stent for acute cholecystitis. Endosc Int Open 2019; 7:E1105-E1114. [PMID: 31475227 PMCID: PMC6715425 DOI: 10.1055/a-0747-5668] [Citation(s) in RCA: 17] [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: 07/05/2018] [Accepted: 09/04/2018] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background and study aims Biliary plastic stents are generally substituted for gallbladder stents in endoscopic transpapillary gallbladder stenting (EGBS), there is no sufficient evidence about what type of plastic stent is suitable. We examined outcomes of EGBS using standard biliary stents and a novel stent for acute cholecystitis and evaluated the efficacy of the novel stent.
Patients and methods Seventy patients with acute cholecystitis in whom EGBS was performed were evaluated retrospectively. We performed EGBS in 23 patients using the novel stent (novel stent group) and 47 patients using standard biliary stents (pigtail: 35, straight: 12) (control group). In the two groups, we examined outcomes of EGBS.
Results There were no significant differences in patient backgrounds or rates of technical success, clinical success, or early adverse events (AE) between the novel stent group and the control groups. However, rates of late AEs were 4.3 % in the novel stent group (liver abscess: 1) and 40.4 % in the control group (stent migration: 15, recurrence of cholecystitis: 4), indicating a significantly higher rate in the control group (P = 0.004). The rate of stent migration was significantly higher in the control group (P = 0.006). Multivariate analysis identified a straight type stent as the risk factor for stent migration (odds ratio: 8.81, 95 % confidence interval: 1.66 – 46.83).
Conclusions The novel stent had significantly lower rates of late AEs and stent migration. Thus, for long-term stent placement, the novel stent was more effective than traditional biliary stents.
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Affiliation(s)
- Kazunari Nakahara
- Department of Gastroenterology and Hepatology, St. Marianna University, School of Medicine, Kawasaki, Japan,Corresponding author Kazunari Nakahara Department of Gastroenterology and HepatologySt. Marianna UniversitySchool of Medicine2-16-1, Sugao, Miyamae-kuKawasaki, 216-8511Japan+81-44-976-5805
| | - Yosuke Michikawa
- Department of Gastroenterology and Hepatology, St. Marianna University, School of Medicine, Kawasaki, Japan
| | - Ryo Morita
- Department of Gastroenterology and Hepatology, St. Marianna University, School of Medicine, Kawasaki, Japan
| | - Keigo Suetani
- Department of Gastroenterology and Hepatology, St. Marianna University, School of Medicine, Kawasaki, Japan
| | - Nozomi Morita
- Department of Gastroenterology and Hepatology, St. Marianna University, School of Medicine, Kawasaki, Japan
| | - Junya Sato
- Department of Gastroenterology and Hepatology, St. Marianna University, School of Medicine, Kawasaki, Japan
| | - Kensuke Tsuji
- Department of Gastroenterology and Hepatology, St. Marianna University, School of Medicine, Kawasaki, Japan
| | - Hiroki Ikeda
- Department of Gastroenterology and Hepatology, St. Marianna University, School of Medicine, Kawasaki, Japan
| | - Kotaro Matsunaga
- Department of Gastroenterology and Hepatology, St. Marianna University, School of Medicine, Kawasaki, Japan
| | - Tsunamasa Watanabe
- Department of Gastroenterology and Hepatology, St. Marianna University, School of Medicine, Kawasaki, Japan
| | - Nobuyuki Matsumoto
- Department of Gastroenterology and Hepatology, St. Marianna University, School of Medicine, Kawasaki, Japan
| | - Shinjiro Kobayashi
- Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Takehito Otsubo
- Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Fumio Itoh
- Department of Gastroenterology and Hepatology, St. Marianna University, School of Medicine, Kawasaki, Japan
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Cao J, Ding X, Wu H, Shen Y, Zheng R, Peng C, Wang L, Zou X. Classification of the cystic duct patterns and endoscopic transpapillary cannulation of the gallbladder to prevent post-ERCP cholecystitis. BMC Gastroenterol 2019; 19:139. [PMID: 31382888 PMCID: PMC6683449 DOI: 10.1186/s12876-019-1053-6] [Citation(s) in RCA: 12] [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: 11/25/2018] [Accepted: 07/21/2019] [Indexed: 02/06/2023] Open
Abstract
Background Endoscopic transpapillary cannulation of the gallbladder is useful but challenging. This study aimed to investigate cystic duct anatomy patterns, which may guide cystic duct cannulation. Methods A total of 226 patients who underwent endoscopic transpapillary cannulation of the gallbladder were analyzed retrospectively. Results According to the cystic duct take-off, 226 cystic duct patterns were divided into 3 patterns: Type I (193, 85.4%), located on the right and angled up; Type II (7, 3.1%), located on the right and angled down; and Type III (26, 11.5%), located on the left and angled up. Type I was further divided into three subtypes: Line type, S type (S1, not surrounding the common bile duct; S2, surrounding the common bile duct), and α type (α1, forward α; α2, reverse α). Types I and III cystic ducts were easier to be cannulated with a higher success rate (85.1 and 86.4%, respectively) compared with Type II cystic duct (75%) despite no statistically significant difference. The reasons for the failure of gallbladder cannulation included invisible cyst duct take-off, severe cyst duct stenosis, impacted stones in cyst duct or neck of the gallbladder, sharply angled cyst duct, and markedly dilated cyst duct with the tortuous valves of Heister. Conclusion Classification of cystic duct patterns was helpful in guiding endoscopic transpapillary gallbladder cannulation.
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Affiliation(s)
- Jun Cao
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, Jiang Su Province, China
| | - Xiwei Ding
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, Jiang Su Province, China
| | - Han Wu
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, Jiang Su Province, China
| | - Yonghua Shen
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, Jiang Su Province, China
| | - Ruhua Zheng
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, Jiang Su Province, China
| | - Chunyan Peng
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, Jiang Su Province, China
| | - Lei Wang
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, Jiang Su Province, China.
| | - Xiaoping Zou
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, Jiang Su Province, China.
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35
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Adler DG. Avoiding the tube: ERCP and EUS approaches to gallbladder drainage as alternatives to percutaneous cholecystostomy in patients with cholecystitis. Gastrointest Endosc 2019; 89:299-300. [PMID: 30665529 DOI: 10.1016/j.gie.2018.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 09/09/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Douglas G Adler
- Therapeutic Endoscopy, Division of Gastroenterology, Hepatology, and Nutrition, University of Utah School of Medicine, Huntsman Cancer Center, Salt Lake City, Utah, USA
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Nabi Z, Korman A, Reddy N, Carr-Locke D. Infections of the Biliary Tract. CLINICAL GASTROINTESTINAL ENDOSCOPY 2019:636-651.e3. [DOI: 10.1016/b978-0-323-41509-5.00055-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Cao J, Peng C, Ding X, Shen Y, Wu H, Zheng R, Wang L, Zou X. Risk factors for post-ERCP cholecystitis: a single-center retrospective study. BMC Gastroenterol 2018; 18:128. [PMID: 30134864 PMCID: PMC6103987 DOI: 10.1186/s12876-018-0854-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 07/31/2018] [Indexed: 12/14/2022] Open
Abstract
Background The risk factors for post-ERCP cholecystitis (PEC) have not been characterized. Hence, this study aimed to identify the potential risk factors for PEC. Methods The medical records of 4238 patients undergoing the first ERCP in a single center from January 2012 to December 2016 were analyzed in this study. A multivariate analysis was used to identify the risk factors. Results This study included 2672 patients who met the enrollment criteria. Of these, 36 patients (incidence rate of 1.35%) developed PEC within 2 weeks of the procedure. Univariate and multivariate analyses identified the following factors associated with PEC: history of acute pancreatitis [odds ratio (OR) = 2.60; 95% confidence interval (CI): 1.29–5.23], history of chronic cholecystitis (OR = 8.47; 95% CI: 2.54–28.24), gallbladder opacification (OR = 2.79; 95% CI: 1.37–5.70), biliary duct metallic stent placement (OR = 3.66; 95% CI: 1.78–7.54), and high leukocyte count before ERCP (OR = 1.10; 95% CI: 1.04–1.17). The prediction model incorporating these factors demonstrated an area under the receiver operating characteristic curve of 0.85 (95% CI, 0.80–0.91). A prognostic nomogram was developed using the aforementioned variables to estimate the probability of PEC. Conclusions The risk factors, including the history of acute pancreatitis, history of chronic cholecystitis, gallbladder opacification, biliary duct metallic stent placement, and high leucocyte counts before ERCP, increased the occurrence of PEC and were positive predictors for PEC. The constructed nomogram was used to estimate the risk of PEC, guiding the implementation of prophylactic measures to prevent PEC in clinical practice.
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Affiliation(s)
- Jun Cao
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Chunyan Peng
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Xiwei Ding
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Yonghua Shen
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Han Wu
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Ruhua Zheng
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Lei Wang
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China. .,Zhongshan Road 321, Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, Jiang Su Province, China.
| | - Xiaoping Zou
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China. .,Zhongshan Road 321, Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, Jiang Su Province, China.
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Manta R, Mutignani M, Galloro G, Conigliaro R, Zullo A. 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: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [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.
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Affiliation(s)
- Raffaele Manta
- Gastroenterology Unit, New Sant'Agostino Estense Civil Hospital, Baggiovara, Modena
| | - Massimiliano Mutignani
- Department of Diagnostic and Interventional Digestive Endoscopy, 'Niguarda Ca-Granda' Hospital, Milan
| | - Giuseppe Galloro
- Department of Clinical Medicine and Surgery, Unit of Surgical Digestive Endoscopy, 'Federico II' University of Naples, Naples
| | - Rita Conigliaro
- Gastroenterology Unit, New Sant'Agostino Estense Civil Hospital, Baggiovara, Modena
| | - Angelo Zullo
- Department of Gastroenterology and Digestive Endoscopy, 'Nuovo Regina Margherita' Hospital, Rome, Italy
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Doi S, Yasuda I, Mabuchi M, Iwata K, Ando N, Iwashita T, Uemura S, Okuno M, Mukai T, Adachi S, Taniguchi K. Hybrid procedure combining endoscopic gallbladder lavage and internal drainage with elective cholecystectomy for acute cholecystitis: A prospective pilot study (The BLADE study). Dig Endosc 2018; 30:501-507. [PMID: 29399891 DOI: 10.1111/den.13028] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 01/28/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIM Percutaneous transhepatic drainage is the most common method for non-operative gallbladder drainage, but the technique does have several disadvantages because of its invasive nature and requirement for continuous drainage. To overcome these disadvantages, we developed a novel procedure, endoscopic gallbladder lavage followed by stent placement, carried out in a single endoscopic session. Our aim was to prospectively evaluate the efficacy and safety of this procedure in patients with acute cholecystitis. METHODS Patients diagnosed with moderate cholecystitis at four tertiary care centers were enrolled in this study. We initially placed a 5-Fr tube to carry out gallbladder lavage. The tube was then cut to the optimal length and placed as a stent. Main outcomes were procedural and clinical success rates. RESULTS The procedure was attempted in 40 patients and was successful in 30 (75.0%). Minor adverse events occurred in two (5.0%) patients: perforation of the cystic duct by the guidewire in one patient and pancreatitis in the other. Among the 30 patients in whom the procedure was successfully done, clinical resolution was obtained in 29 (96.6%). Elective cholecystectomy was carried out in 37 patients (92.5%), with a median delay after drainage of 42 days (range, 12-138 days). There were no adverse events during the waiting period. CONCLUSIONS Gallbladder rinsing followed by internal drainage using a 5-Fr nasobiliary tube is considered an effective and safe alternative to other techniques, providing an acceptable success rate in patients with acute cholecystitis prior to elective surgery. CLINICAL TRIAL INFORMATION http://www.umin.ac.jp/ctr/index.htm (ID: UMIN-000009680).
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Affiliation(s)
- Shinpei Doi
- Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan
| | - Ichiro Yasuda
- Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan
| | - Masatoshi Mabuchi
- Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan
| | - Keisuke Iwata
- Department of Gastroenterology, Gifu Prefectural Medical Center, Gifu, Japan
| | - Nobuhiro Ando
- Department of Gastroenterology, Gifu Prefectural Medical Center, Gifu, Japan
| | - Takuji Iwashita
- First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
| | - Shinya Uemura
- First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
| | - Mitsuru Okuno
- First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
| | - Tsuyoshi Mukai
- Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan
| | - Seiji Adachi
- First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
| | - Keizo Taniguchi
- Department of Surgery, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan
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Long-Term Management of Recurrent Cholecystitis after Initial Conservative Treatment: Endoscopic Transpapillary Gallbladder Stenting. Can J Gastroenterol Hepatol 2018; 2018:3983707. [PMID: 29850454 PMCID: PMC5925167 DOI: 10.1155/2018/3983707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 12/19/2017] [Accepted: 01/14/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Endoscopic transpapillary gallbladder stenting (ETGBS) is an effective procedure for treating high-risk patients with acute cholecystitis and severe comorbidities. However, the efficacy of ETGBS for recurrent cholecystitis (RC) remains unclear. This study aimed to explore its efficacy in patients with RC for whom cholecystectomy is contraindicated because of its high surgical risk. METHODS Data on 19 high-risk patients who had undergone ETGBS for RC after initial conservative therapy in our institution between June 2006 and May 2012 were retrospectively examined. The primary outcome was the clinical success rate, which was defined as no recurrences of acute cholecystitis after ETGBS until death or the end of the follow-up period. Secondary outcomes were technical success rate and adverse events (AEs). RESULTS The clinical success rate of ETGBS was 100%, the technical success rate 94.7%, and AE rate 5%: one patient developed procedure-related mild acute pancreatitis. The clinical courses of all patients were as follows: four died of nonbiliary disease, and the remaining 15 were subsequently treated conservatively. The median duration of follow-up was 14.95 months (range 3-42 months). CONCLUSIONS ETGBS is an effective alternative for managing RC in high-risk patients with severe comorbidities.
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Affiliation(s)
- Douglas G Adler
- Department of Gastroenterology and Hepatology, Huntsman Cancer Center, University of Utah School of Medicine, Salt Lake City, Utah 84124, USA
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Mori Y, Itoi T, Baron TH, Takada T, Strasberg SM, Pitt HA, Ukai T, Shikata S, Noguchi Y, Teoh AYB, Kim MH, Asbun HJ, Endo I, Yokoe M, Miura F, Okamoto K, Suzuki K, Umezawa A, Iwashita Y, Hibi T, Wakabayashi G, Han HS, Yoon YS, Choi IS, Hwang TL, Chen MF, Garden OJ, Singh H, Liau KH, Huang WSW, Gouma DJ, Belli G, Dervenis C, de Santibañes E, Giménez ME, Windsor JA, Lau WY, Cherqui D, Jagannath P, Supe AN, Liu KH, Su CH, Deziel DJ, Chen XP, Fan ST, Ker CG, Jonas E, Padbury R, Mukai S, Honda G, Sugioka A, Asai K, Higuchi R, Wada K, Yoshida M, Mayumi T, Hirata K, Sumiyama Y, Inui K, Yamamoto M. Tokyo Guidelines 2018: management strategies for gallbladder drainage in patients with acute cholecystitis (with videos). JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2018; 25:87-95. [PMID: 28888080 DOI: 10.1002/jhbp.504] [Citation(s) in RCA: 206] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Since the publication of the Tokyo Guidelines in 2007 and their revision in 2013, appropriate management for acute cholecystitis has been more clearly established. Since the last revision, several manuscripts, especially for alternative endoscopic techniques, have been reported; therefore, additional evaluation and refinement of the 2013 Guidelines is required. We describe a standard drainage method for surgically high-risk patients with acute cholecystitis and the latest developed endoscopic gallbladder drainage techniques described in the updated Tokyo Guidelines 2018 (TG18). Our study confirmed that percutaneous transhepatic gallbladder drainage should be considered the first alternative to surgical intervention in surgically high-risk patients with acute cholecystitis. Also, endoscopic transpapillary gallbladder drainage or endoscopic ultrasound-guided gallbladder drainage can be considered in high-volume institutes by skilled endoscopists. In the endoscopic transpapillary approach, either endoscopic naso-gallbladder drainage or gallbladder stenting can be considered for gallbladder drainage. We also introduce special techniques and the latest outcomes of endoscopic ultrasound-guided gallbladder drainage studies. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.
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Affiliation(s)
- Yasuhisa Mori
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Todd H Baron
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Tadahiro Takada
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Steven M Strasberg
- Section of Hepato-Pancreato-Biliary Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Henry A Pitt
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Tomohiko Ukai
- Department of Family Medicine, Mie Prefectural Ichishi Hospital, Mie, Japan
| | | | - Yoshinori Noguchi
- Department of General Internal Medicine, Japanese Red Cross Nagoya Daini Hospital, Aichi, Japan
| | | | - Myung-Hwan Kim
- Department of Gastroenterology, University of Ulsan College of Medicine, Seoul, Korea
| | - Horacio J Asbun
- Department of Surgery, Mayo Clinic College of Medicine, Florida, USA
| | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Masamichi Yokoe
- Department of General Internal Medicine, Japanese Red Cross Nagoya Daini Hospital, Aichi, Japan
| | - Fumihiko Miura
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Kohji Okamoto
- Department of Surgery, Center for Gastroenterology and Liver Disease, Kitakyushu City Yahata Hospital, Fukuoka, Japan
| | - Kenji Suzuki
- Department of Surgery, Fujinomiya City General Hospital, Shizuoka, Japan
| | - Akiko Umezawa
- Minimally Invasive Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Yukio Iwashita
- Department of Gastroenterological and Pediatric Surgery, Oita University, Faculty of Medicine, Oita, Japan
| | - Taizo Hibi
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Go Wakabayashi
- Department of Surgery, Ageo Central General Hospital, Saitama, Japan
| | - Ho-Seong Han
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yoo-Seok Yoon
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - In-Seok Choi
- Department of Surgery, Konyang University Hospital, Daejeon, Korea
| | - Tsann-Long Hwang
- Division of General Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Miin-Fu Chen
- Division of General Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - O James Garden
- Clinical Surgery, University of Edinburgh, Edinburgh, UK
| | - Harjit Singh
- Department of Hepato-Pancreato-Biliary Surgery, Hospital Selayang, Malaysia
| | - Kui-Hin Liau
- Liau KH Consulting PL, Mt Elizabeth Novena Hospital, Singapore& Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Dirk J Gouma
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Giulio Belli
- Department of General and HPB Surgery, Loreto Nuovo Hospital, Naples, Italy
| | | | - Eduardo de Santibañes
- Department of Surgery, Hospital Italiano, University of Buenos Aires, Buenos Aires, Argentina
| | - Mariano Eduardo Giménez
- Chair of General Surgery and Minimal Invasive Surgery "Taquini", University of Buenos Aires Argentina, DAICIM Foundation, Argentina
| | - John A Windsor
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Wan Yee Lau
- Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Daniel Cherqui
- Hepatobiliary Center, Paul Brousse Hospital, Villejuif, France
| | - Palepu Jagannath
- Department of Surgical Oncology, Lilavati Hospital and Research Centre, Mumbai, India
| | - Avinash Nivritti Supe
- Department of Surgical Gastroenterology, Seth G S Medical College and K E M Hospital, Mumbai, India
| | - Keng-Hao Liu
- Division of General Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Cheng-Hsi Su
- Department of Surgery, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Daniel J Deziel
- Department of Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Xiao-Ping Chen
- Hepatic Surgery Centre, Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sheung Tat Fan
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
| | - Chen-Guo Ker
- Department of Surgery, Yuan's General Hospital, Kaohsiung, Taiwan
| | - Eduard Jonas
- Surgical Gastroenterology/Hepatopancreatobiliary Unit, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Robert Padbury
- Division of Surgical and Specialty Services, Flinders Medical Centre, Adelaide, Australia
| | - Shuntaro Mukai
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Goro Honda
- Department of Surgery, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - Atsushi Sugioka
- Department of Surgery, Fujita Health University School of Medicine, Aichi, Japan
| | - Koji Asai
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Ryota Higuchi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Keita Wada
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Masahiro Yoshida
- Department of Hemodialysis and Surgery, Chemotherapy Research Institute Kaken Hospital, International University of Health and Welfare, Chiba, Japan
- Department of EBM and Guidelines, Japan Council for Quality Health Care, Tokyo, Japan
| | - Toshihiko Mayumi
- Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Koichi Hirata
- Department of Surgery, JR Sapporo Hospital, Hokkaido, Japan
| | | | - Kazuo Inui
- Department of Gastroenterology, Second Teaching Hospital, Fujita Health University, Aichi, Japan
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
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Chan JHY, Teoh AYB. Current Status of Endoscopic Gallbladder Drainage. Clin Endosc 2017; 51:150-155. [PMID: 29145349 PMCID: PMC5903090 DOI: 10.5946/ce.2017.125] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 08/26/2017] [Indexed: 12/30/2022] Open
Abstract
The gold standard for treatment of acute cholecystitis is laparoscopic cholecystectomy. However, cholecystectomy is often not suitable for surgically unfit patients who are too frail due to various co-morbidities. As such, several less invasive endoscopic treatment modalities have been developed to control sepsis, either as a definitive treatment or as a temporizing modality until the patient is stable enough to undergo cholecystectomy at a later stage. Recent developments in endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) with endoscopic ultrasound EUS-specific stents having lumen-apposing properties have demonstrated potential as a definitive treatment modality. Furthermore, advanced gallbladder procedures can be performed using the stents as a portal. With similar effectiveness as percutaneous transhepatic cholecystostomy and lower rates of adverse events reported in some studies, EUS-GBD has opened exciting possibilities in becoming the next best alternative in treating acute cholecystitis in surgically unfit patients. The aim of this review article is to provide a summary of the various methods of gallbladder drainage GBD with particular focus on EUS-GBD and the many new prospects it allows.
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Affiliation(s)
- Joey Ho Yi Chan
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR China
| | - Anthony Yuen Bun Teoh
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR China
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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: 1.1] [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.
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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
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Abstract
The gold standard for the management of acute cholecystitis is laparoscopic cholecystectomy. In patients that are not fit for surgery, percutaneous cholecystostomy is the standard treatment. However, the procedure is only a temporary measure for controlling gallbladder symptoms and it is frequently associated with morbidities. Recently, endoscopic options for management of acute cholecystitis have been developed. The approach avoids the need for a percutaneous drain and may allow endoscopic treatment of the gallstone. The aim of this article is to provide an overview on the current status of endoscopic management of acute cholecystitis.
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46
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Khan MA, Atiq O, Kubiliun N, Ali B, Kamal F, Nollan R, Ismail MK, Tombazzi C, Kahaleh M, Baron TH. Efficacy and safety of endoscopic gallbladder drainage in acute cholecystitis: Is it better than percutaneous gallbladder drainage? Gastrointest Endosc 2017; 85:76-87.e3. [PMID: 27343412 DOI: 10.1016/j.gie.2016.06.032] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 06/12/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS The efficacy and safety of endoscopic gallbladder drainage (EGBD) performed via endoscopic retrograde cholangiography (ERC)-based transpapillary stenting or EUS-based transmural stenting are unknown. We aimed to conduct a proportion meta-analysis to evaluate the cumulative efficacy and safety of these procedures and to compare them with percutaneous gallbladder drainage (PGBD). METHODS We searched several databases from inception through December 10, 2015 to identify studies (with 10 or more patients) reporting technical success and postprocedure adverse events of EGBD. Weighted pooled rates (WPRs) for technical and clinical success, postprocedure adverse events, and recurrent cholecystitis were calculated for both methods of EGBD. Pooled odds ratios (ORs) were also calculated to compare the technical success and postprocedure adverse events in patients undergoing EGBD versus PGBD. RESULTS The WPRs with 95% confidence intervals (CIs) of technical success, clinical success, postprocedure adverse events, and recurrent cholecystitis for ERC-based transpapillary drainage were 83% (95% CI, 78%-87%; I2 = 38%), 93% (95% CI, 89%-96%; I2 = 39%), 10% (95% CI, 7%-13%; I2 = 27%), and 3% (95% CI, 1%-5%; I2 = 0%), respectively. The WPRs for EUS-based drainage for technical success, clinical success, postprocedure adverse events, and recurrent cholecystitis were 93% (95% CI, 87%-96%; I2 = 0%), 97% (95% CI, 93%-99%; I2 = 0%), 13% (95% CI, 8%-19%; I2 = 0%), and 4% (95% CI, 2%-9%; I2 = 0%), respectively. On proportionate difference, EUS-based drainage had better technical (10%) and clinical success (4%) in comparison with ERC-based drainage. The pooled OR for technical success of EGBD versus PGBD was .51 (95% CI, .09-2.88; I2 = 23%) and for postprocedure adverse events was .33 (95% CI, .14-.80; I2 = 16%) in favor of EGBD. CONCLUSIONS EGBD is an efficacious and safe therapeutic modality for treatment of patients with acute cholecystitis who cannot undergo surgery. EGBD shows a similar technical success as PGBD but appears to be safer than PGBD.
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Affiliation(s)
- Muhammad Ali Khan
- Division of Gastroenterology and Hepatology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Omair Atiq
- Division of Digestive and Liver Diseases, University of Texas, Southwestern Medical Center, Dallas, Texas, USA
| | - Nisa Kubiliun
- Division of Digestive and Liver Diseases, University of Texas, Southwestern Medical Center, Dallas, Texas, USA
| | - Bilal Ali
- Division of Gastroenterology and Hepatology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Faisal Kamal
- Division of Gastroenterology and Hepatology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Richard Nollan
- University of Tennessee Health Science Center Library, Memphis, Tennessee, USA
| | - Mohammad Kashif Ismail
- Division of Gastroenterology and Hepatology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Claudio Tombazzi
- Division of Gastroenterology and Hepatology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Michel Kahaleh
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, Cornell University, New York, New York, USA
| | - Todd H Baron
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA
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Nam K, Choi JH. Conversion of Percutaneous Cholecystostomy to Endoscopic Gallbladder Stenting by Using the Rendezvous Technique. Clin Endosc 2016; 50:301-304. [PMID: 27817191 PMCID: PMC5475519 DOI: 10.5946/ce.2016.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 09/27/2016] [Accepted: 09/28/2016] [Indexed: 11/26/2022] Open
Abstract
We report the successful conversion of percutaneous cholecystostomy (PC) to endoscopic transpapillary gallbladder stenting (ETGS) with insertion of an antegrade guidewire into the duodenum. An 84-year-old man presented with severe acute cholecystitis and septic shock. He had significant comorbidities, and emergent PC was successfully performed. Subsequent ETGS was attempted but unsuccessful owing to difficulties with cystic duct cannulation. However, via the PC tract, the guidewire was passed antegradely into the duodenum, and ETGS with a double-pigtail plastic stent was successfully performed with the rendezvous technique. The PC tube was removed, and no recurrence was reported during the 17-month follow-up period. Conversion of PC to ETGS is a viable option in patients with acute cholecystitis who are not candidates for surgery. Antegrade guidewire insertion via the PC tract may increase the success rate of conversion and decrease the risk of procedure-related complications.
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Affiliation(s)
- Kwangwoo Nam
- Division of Gastroenterology, Department of Internal Medicine, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
| | - Jun-Ho Choi
- Division of Gastroenterology, Department of Internal Medicine, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
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Yang MJ, Yoo BM, Kim JH, Hwang JC, Baek NH, Kim SS, Lim SG, Kim JH, Shin SJ, Cheong JY, Lee KM, Lee KJ, Kim WH, Cho SW. Endoscopic naso-gallbladder drainage versus gallbladder stenting before cholecystectomy in patients with acute cholecystitis and a high suspicion of choledocholithiasis: a prospective randomised preliminary study. Scand J Gastroenterol 2016; 51:472-8. [PMID: 26595503 DOI: 10.3109/00365521.2015.1115116] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Endoscopic transpapillary gallbladder drainage using a nasocystic tube or plastic stent has been attempted as an alternative to percutaneous drainage for patients with acute cholecystitis who are not candidates for urgent cholecystectomy. We aimed to assess the efficacy of single-step endoscopic drainage of the common bile duct and gallbladder, and to evaluate which endoscopic transpapillary gallbladder drainage method is ideal as a bridge before elective cholecystectomy. MATERIALS AND METHODS From July 2011 to December 2014, 35 patients with acute moderate-to-severe cholecystitis and a suspicion of choledocholithiasis were randomly assigned to the endoscopic naso-gallbladder drainage (ENGBD) (n = 17) or endoscopic gallbladder stenting (EGBS) (n = 18) group. RESULTS Bile duct clearance was performed successfully in all cases. No significant differences were found between the ENGBD and EGBS groups in the technical success rates [82.4% (14/17) vs. 88.9% (16/18), p = 0.658] and clinical success rates [by intention-to-treat analysis: 70.6% (12/17) vs. 83.3% (15/18), p = 0.443; by per protocol analysis of technically feasible cases: 85.7% (12/14) vs. 93.8% (15/16), p = 0.586]. Three ENGBD patients and two EGBS patients experienced adverse events (p = 0.658). No significant differences were found in operation time or rate of conversion to open cholecystectomy. CONCLUSIONS Single-step endoscopic transpapillary drainage of the common bile duct and gallbladder seems to be an acceptable therapeutic modality in patients with acute cholecystitis and a suspicion of choledocholithiasis. There were no significant differences in the technical and clinical outcomes between ENGBD and EGBS as a bridge before cholecystectomy.
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Affiliation(s)
- Min Jae Yang
- a Department of Gastroenterology , Ajou University School of Medicine , Suwon , South Korea
| | - Byung Moo Yoo
- a Department of Gastroenterology , Ajou University School of Medicine , Suwon , South Korea
| | - Jin Hong Kim
- a Department of Gastroenterology , Ajou University School of Medicine , Suwon , South Korea
| | - Jae Chul Hwang
- a Department of Gastroenterology , Ajou University School of Medicine , Suwon , South Korea
| | - Nam Hyun Baek
- b Department of Surgery , Ajou University School of Medicine , Suwon , South Korea
| | - Soon Sun Kim
- a Department of Gastroenterology , Ajou University School of Medicine , Suwon , South Korea
| | - Sun Gyo Lim
- a Department of Gastroenterology , Ajou University School of Medicine , Suwon , South Korea
| | - Ji Hun Kim
- b Department of Surgery , Ajou University School of Medicine , Suwon , South Korea
| | - Sung Jae Shin
- a Department of Gastroenterology , Ajou University School of Medicine , Suwon , South Korea
| | - Jae Youn Cheong
- a Department of Gastroenterology , Ajou University School of Medicine , Suwon , South Korea
| | - Kee Myung Lee
- a Department of Gastroenterology , Ajou University School of Medicine , Suwon , South Korea
| | - Kwang Jae Lee
- a Department of Gastroenterology , Ajou University School of Medicine , Suwon , South Korea
| | - Wook Hwan Kim
- b Department of Surgery , Ajou University School of Medicine , Suwon , South Korea
| | - Sung Won Cho
- a Department of Gastroenterology , Ajou University School of Medicine , Suwon , South Korea
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Inoue T, Okumura F, Kachi K, Fukusada S, Iwasaki H, Ozeki T, Suzuki Y, Anbe K, Nishie H, Mizushima T, Sano H. Long-term outcomes of endoscopic gallbladder stenting in high-risk surgical patients with calculous cholecystitis (with videos). Gastrointest Endosc 2016; 83:905-13. [PMID: 26364963 DOI: 10.1016/j.gie.2015.08.072] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 08/26/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Recently, endoscopic gallbladder stenting (EGBS) has been performed to prevent recurrences in high-risk surgical patients with cholecystitis. However, evidence regarding the long-term outcomes of EGBS is sparse. We investigated the cholecystitis recurrence rate in high-risk surgical patients with acute calculous cholecystitis and compared the cholecystitis recurrence rates in patients in whom EGBS was performed with those in patients who were observed after percutaneous drainage. METHODS We studied 64 consecutive high-risk surgical patients with acute calculous cholecystitis who required gallbladder decompression between 2007 and 2014. We divided the patient cohort into patients who underwent observation after percutaneous drainage between 2007 and 2011 (OAPD group) and those who underwent EGBS between 2012 and 2014 (EGBS group), and we compared the groups. RESULTS The technical success rate of EGBS was 82.9% based on the intention-to-treat analysis. The cholecystitis recurrence rates were 17.2% in the OAPD group and 0% in the EGBS group, a difference that was significant (P = .043). There was also a significant difference between the groups with respect to the time to recurrent cholecystitis, which was determined by using Kaplan-Meier analysis (P = .015). The overall biliary event rates were 24.1% in the OAPD group and 9.1% in the EGBS group, and no significant difference was noted (P = .207). CONCLUSION EGBS reduced the recurrence of cholecystitis in high-risk surgical patients with calculous cholecystitis. However, stent-related adverse events may occur, and modifications are necessary to reduce these.
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Affiliation(s)
- Tadahisa Inoue
- Department of Gastroenterology, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | - Fumihiro Okumura
- Department of Gastroenterology, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | - Kenta Kachi
- Department of Gastroenterology, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | - Shigeki Fukusada
- Department of Gastroenterology, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | - Hiroyasu Iwasaki
- Department of Gastroenterology, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | - Takanori Ozeki
- Department of Gastroenterology, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | - Yuta Suzuki
- Department of Gastroenterology, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | - Kaiki Anbe
- Department of Gastroenterology, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | - Hirotada Nishie
- Department of Gastroenterology, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | - Takashi Mizushima
- Department of Gastroenterology, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | - Hitoshi Sano
- Department of Gastroenterology, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
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Patil R, Ona MA, Papafragkakis C, Anand S, Duddempudi S. Endoscopic ultrasound-guided placement of the lumen-apposing self-expandable metallic stent for gallbladder drainage: a promising technique. Ann Gastroenterol 2016; 29:162-7. [PMID: 27065728 PMCID: PMC4805735 DOI: 10.20524/aog.2016.0001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Acute cholecystitis and other clinical problems requiring gallbladder removal or drainage have conventionally been treated with surgery, endoscopic retrograde cholangiopancreatography or percutaneous transhepatic drainage of the gallbladder and/or extrahepatic bile duct. Patients unable to undergo these procedures due to functional status or anatomical anomalies are candidates for endoscopic ultrasound (EUS)-guided gallbladder drainage with stent placement. The aim of this review was to evaluate the technical feasibility and efficacy of EUS-guided placement of the recently developed lumen-apposing self-expandable metallic stent (LASEMS). A literature review was performed to identify the studies describing this technique. In this review article we have summarized case series or reports describing EUS-guided LASEMS placement. The indications, techniques, limitations and complications reported are discussed. A total of 78 patients were included across all studies described thus far in the literature. Studies have reported near 100% technical and clinical success rates in selected cases. No major complications were reported. EUS-guided gallbladder drainage and LASEMS placement can be a safe and effective alternative approach in the management of selected patients.
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Affiliation(s)
- Rashmee Patil
- Department of Internal Medicine, Mount Sinai Health Systems New York, New York (Rashmee Patil), USA
| | - Mel A Ona
- Department of Gastroenterology and Hepatology, The Brooklyn Hospital Center Academic Affiliate of The Icahn School of Medicine at Mount Sinai Clinical Affiliate of The Mount Sinai Hospital Brooklyn, New York (Mel A. Ona, Sury Anand, Sushil Duddempudi), USA
| | - Charilaos Papafragkakis
- Advanced Therapeutic Endoscopy, MD Anderson Cancer Center Academic and Clinical Affiliate of the University of Texas, Houston, Texas (Charilaos Papafragkakis), USA
| | - Sury Anand
- Department of Gastroenterology and Hepatology, The Brooklyn Hospital Center Academic Affiliate of The Icahn School of Medicine at Mount Sinai Clinical Affiliate of The Mount Sinai Hospital Brooklyn, New York (Mel A. Ona, Sury Anand, Sushil Duddempudi), USA
| | - Sushil Duddempudi
- Department of Gastroenterology and Hepatology, The Brooklyn Hospital Center Academic Affiliate of The Icahn School of Medicine at Mount Sinai Clinical Affiliate of The Mount Sinai Hospital Brooklyn, New York (Mel A. Ona, Sury Anand, Sushil Duddempudi), USA
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