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EUS-guided gallbladder drainage: Where will we go next?

Published:April 08, 2021DOI:https://doi.org/10.1016/j.gie.2021.03.933
      EUS-guided gallbladder drainage (EUS-GBD) recently emerged as a novel minimally invasive therapeutic intervention, an alternative to percutaneous cholecystostomy (PT-GBD), for patients at high surgical risk with acute cholecystitis (AC).
      • Tyberg A.
      • Saumoy M.
      • Sequeiros E.V.
      • et al.
      EUS-guided versus percutaneous gallbladder drainage: isn't it time to convert?.
      The advent of lumen-apposing metal stents (LAMSs), allowing adherence of the mobile gallbladder with the gastric/duodenal lumen and formation of a permanent fistulous tract through which therapeutic maneuvers are feasible, rendered EUS-GBD safe.
      • Crino S.F.
      • Rimbaș M.
      • Gabbrielli A.
      • et al.
      Endoscopic ultrasound guided gallbladder interventions: a review of the current literature.
      The procedure has high rates of technical and clinical success, a favorable safety profile,
      • Kahaleh M.
      • Perez-Miranda M.
      • Artifon E.L.
      • et al.
      International collaborative study on EUS-guided gallbladder drainage: are we ready for prime time?.
      • Dollhopf M.
      • Larghi A.
      • Will U.
      • et al.
      EUS-guided gallbladder drainage in patients with acute cholecystitis and high surgical risk using an electrocautery-enhanced lumen-apposing metal stent device.
      • Teoh A.Y.
      • Perez-Miranda M.
      • Kunda R.
      • et al.
      Outcomes of an international multicenter registry on EUS-guided gallbladder drainage in patients at high risk for cholecystectomy.
      and a low risk of recurrent AC.
      • Choi J.H.
      • Lee S.S.
      • Choi J.H.
      • et al.
      Long-term outcomes after endoscopic ultrasonography-guided gallbladder drainage for acute cholecystitis.
      ,
      • Kamata K.
      • Takenaka M.
      • Kitano M.
      • et al.
      Endoscopic ultrasound-guided gallbladder drainage for acute cholecystitis: long-term outcomes after removal of a self-expandable metal stent.
      Several retrospective studies and meta-analyses favored EUS-GBD over PT-GBD.
      • Luk S.W.
      • Irani S.
      • Krishnamoorthi R.
      • et al.
      Endoscopic ultrasound-guided gallbladder drainage versus percutaneous cholecystostomy for high risk surgical patients with acute cholecystitis: a systematic review and meta-analysis.
      However, the recently updated Tokyo guidelines still prefer PT-GBD as a primary treatment for AC patients at high surgical risk, leaving EUS-GBD as a valid option only for experienced endosonographers working in high-volume centers.
      • Mori Y.
      • Itoi T.
      • Baron T.H.
      • et al.
      Tokyo Guidelines 2018: management strategies for gallbladder drainage in patients with acute cholecystitis (with videos).

      Abbreviations:

      AC (acute cholecystitis), AE (adverse event), COC (conversion of LC to open cholecystectomy), EUS-GBD (EUS-guided gallbladder drainage), LAMS (lumen-apposing metal stent), LC (laparoscopic cholecystectomy), PT-GBD (percutaneous cholecystostomy)
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