Background and Aims
Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using an anti-migrating
tubular self-expandable metal stent (ATSEMS) is performed in high surgical risk patients
with acute cholecystitis. The newly introduced lumen-apposing metal stent (LAMS) is
expected to reduce the risk of tubular self-expandable metal stent–related adverse
events such as stent migration, but no comparative studies have been carried out between
LAMSs and ATSEMSs for EUS-GBD.
Methods
We reviewed the prospectively collected EUS-GBD database at Asan Medical Center and
Bucheon Soonchunhyang hospital to analyze consecutive patients with acute cholecystitis
who underwent EUS-GBD with LAMSs or ATSEMSs between January 2015 and December 2017.
Technical success, clinical success, adverse events, and recurrence of cholecystitis
were evaluated.
Results
A total of 71 patients (36 with LAMSs, 35 with ATSEMSs) were analyzed. The LAMS group
had longer median procedure time (15.5 minutes) than the ATSEMS group (11 minutes;
P = .017). The 2 groups did not show significant differences in terms of technical
success (LAMS, 94% vs ATSEMS, 100%; P = .49), clinical success (94% vs 100%; P = .49), procedure-related adverse events (0% vs 2.9%; P = .99), and stent-related late adverse events (11.8% vs 5.8%; P = .43). During follow-up, the 2 groups had similar rates of cholecystitis recurrence
at 6 months (LAMS, 3.4% vs ATSEMS, 3.1%, P = .99) and 12 months (8.3% vs 3.1%, P = .56).
Conclusions
In high surgical risk patients with acute cholecystitis, LAMSs and ATSEMSs for EUS-GBD
showed similar rates of technical success, clinical success, procedure-related adverse
events, stent-related late adverse events, and recurrence of cholecystitis.
Graphical abstract
Graphical Abstract
Abbreviations:
ATSEMS (anti-migrating tubular self-expandable metal stent), EUS-GBD (endoscopic ultrasound-guided gallbladder drainage), IQR (interquartile range), LAMS (lumen-apposing metal stent), PTC (percutaneous cholecystostomy)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Gastrointestinal EndoscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Prospective randomized study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis.Ann Surg. 1998; 227: 461-467
- Tokyo Guidelines 2018: management bundles for acute cholangitis and cholecystitis.J Hepatobiliary Pancreat Sci. 2018; 25: 96-100
- Early cholecystectomy for acute cholecystitis in the elderly population: a systematic review and meta-analysis.Dig Surg. 2017; 34: 371-379
- Percutaneous transhepatic cholecystostomy: effective treatment of acute cholecystitis in high risk patients.Isr Med Assoc J. 2002; 4: 331-333
- Clinical outcomes of a percutaneous cholecystostomy for acute cholecystitis: a multicentre analysis.HPB (Oxford). 2013; 15: 511-516
- Endoscopic ultrasound-guided gallbladder drainage reduces adverse events compared with percutaneous cholecystostomy in patients who are unfit for cholecystectomy.Endoscopy. 2017; 49: 130-138
- Endoscopic ultrasound-guided transmural and percutaneous transhepatic gallbladder drainage are comparable for acute cholecystitis.Gastroenterology. 2012; 142: 805-811
- Efficacy and safety of endoscopic gallbladder drainage in acute cholecystitis: Is it better than percutaneous gallbladder drainage?.Gastrointest Endosc. 2017; 85: 76-87.e3
- Endoscopic ultrasound-guided gallbladder drainage for acute cholecystitis: Long-term outcomes after removal of a self-expandable metal stent.World J Gastroenterol. 2017; 23: 661-667
- EUS-guided gallbladder drainage with a lumen-apposing metal stent (with video).Gastrointest Endosc. 2015; 82: 1110-1115
- Feasibility and safety of endoscopic ultrasound-guided gallbladder drainage using a newly designed lumen-apposing metal stent.Surg Endosc. 2019; 33: 2135-2141
- Long-term outcomes after endoscopic ultrasonography-guided gallbladder drainage for acute cholecystitis.Endoscopy. 2014; 46: 656-661
- EUS-guided cholecystostomy versus endoscopic transpapillary cholecystostomy for acute cholecystitis in high-risk surgical patients.Gastrointest Endosc. 2019; 89: 289-298
- Feasibility and safety of EUS-guided transgastric/transduodenal gallbladder drainage with single-step placement of a modified covered self-expandable metal stent in patients unsuitable for cholecystectomy.Gastrointest Endosc. 2011; 74: 176-181
- Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos).J Hepatobiliary Pancreat Sci. 2018; 25: 41-54
- EUS-guided versus percutaneous gallbladder drainage: isn't it time to convert?.J Clin Gastroenterol. 2018; 52: 79-84
- Endoscopic ultrasound-guided transmural stenting for gallbladder drainage in high-risk patients with acute cholecystitis: a systematic review and pooled analysis.Surg Endosc. 2016; 30: 5200-5208
- EUS-guided gall bladder drainage with a lumen-apposing metal stent: a prospective long-term evaluation.Gut. 2016; 65: 6-8
- Endoscopic ultrasound guided choledocho-enterostomy by using lumen apposing metal stent in patients with failed endoscopic retrograde cholangiopancreatography: a literature review.Digestion. 2018; 98: 1-10
- Feasibility of per-oral cholecystoscopy and advanced gallbladder interventions after EUS-guided gallbladder stenting (with video).Gastrointest Endosc. 2017; 85: 1225-1232
Article info
Publication history
Published online: October 17, 2019
Accepted:
September 27,
2019
Received:
June 12,
2019
Footnotes
DISCLOSURE: All authors disclosed no financial relationships.
Identification
Copyright
© 2020 by the American Society for Gastrointestinal Endoscopy
ScienceDirect
Access this article on ScienceDirectLinked Article
- Role of different types of stents in EUS-guided gallbladder drainageGastrointestinal EndoscopyVol. 91Issue 4
- PreviewWe read with great interest the original article “Comparison of the effectiveness and safety of lumen-apposing metal stent and antimigrating tubular self-expandable metal stent for EUS-guided gallbladder drainage in high surgical risk patients with acute cholecystitis,” by Cho et al.1 In this retrospective study, the authors concluded that lumen-apposing metal stents (LAMSs) and antimigrating tubular self-expandable metal stents (ATSEMSs) for EUS-guided gallbladder drainage (EUS-GBD) showed similar success rates, procedure-related adverse events, and cholecystitis recurrence.
- Full-Text
- Preview
