ObjectiveThe optimal management of acute cholecystitis in patients at very high risk for cholecystectomy is uncertain. The aim of the current study was to compare endoscopic ultrasound (EUS)-guided gallbladder drainage (EUS-GBD) to percutaneous cholecystostomy (PT-GBD) as a definitive treatment in these patients under a randomised controlled trial.DesignConsecutive patients suffering from acute calculous cholecystitis but were at very high-risk for cholecystectomy were recruited. The primary outcome was the 1-year adverse events rate. Secondary outcomes include technical and clinical success, 30-day adverse events, pain scores, unplanned readmissions, re-interventions and mortalities.ResultsBetween August 2014 to February 2018, 80 patients were recruited. EUS-GBD significantly reduced 1 year adverse events (10 (25.6%) vs 31 (77.5%), p<0.001), 30-day adverse events (5 (12.8%) vs 19 (47.5%), p=0.010), re-interventions after 30 days (1/39 (2.6%) vs 12/40 (30%), p=0.001), number of unplanned readmissions (6/39 (15.4%) vs 20/40 (50%), p=0.002) and recurrent cholecystitis (1/39 (2.6%) vs 8/40 (20%), p=0.029). Postprocedural pain scores and analgesic requirements were also less (p=0.034). The technical success (97.4% vs 100%, p=0.494), clinical success (92.3% vs 92.5%, p=1) and 30-day mortality (7.7% vs 10%, p=1) were statistically similar. The predictor to recurrent acute cholecystitis was the performance of PT-GBD (OR (95% CI)=5.63 (1.20–53.90), p=0.027).ConclusionEUS-GBD improved outcomes as compared to PT-GBD in those patients that not candidates for cholecystectomy. EUS-GBD should be the procedure of choice provided that the expertise is available after a multi-disciplinary meeting. Further studies are required to determine the long-term efficacy.Trial registration numberNCT02212717

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Maintaining good general hygiene is an important aspect to prevent coronavirus disease (COVID-19), but there has been much controversy regarding face mask use in the community setting (1). The World Health Organization (WHO) does not recommend that healthy people wear a mask routinely (2), whereas the CDC has recently shifted to recommend wearing cloth face coverings in public (3) because of the evolving pandemic and new study findings on asymptomatic and presymptomatic virus transmission (4, 5). In many Asian countries such as China and Japan, the use of face masks in this pandemic is ubiquitous and is considered hygiene etiquette, whereas in many Western countries, its use in the public is less common. The discrepant behaviors between cultures have induced stigmatization and have even caused a rash of racism on several occasions. To explore the relationship between public interest in face masks and the COVID-19 epidemic, we retrieved the global incidence data and Google Trends relative search volume (RSV) data on the topic "surgical mask" until May 20, 2020. We observed a divergent pattern of RSV values along the timeline of COVID-19, with some geographical regions having peak RSV values early in the epidemic (Figure 1 and Table E1 in the online supplement). This led us to ask whether early awareness on face mask use could help contain the outbreak. We further retrieved the RSV data over the early epidemic period from January 21, 2020 (when WHO published the first Situation Report) to March 11, 2020 (when WHO officially declared a pandemic), and correlated with the epidemics in different regions indicated by the average daily number of COVID-19 cases (6). We observed a significant inverse correlation, with a Kendall rank correlation coefficient (t) of 20.47 (P = 2.4 3 10 25) among 42 geographical regions from six continents. Notably, lower numbers of daily cases were seen in several Asian regions that correlated with high search volumes (Figure 2). Partial correlation analysis showed that this correlation remained independently significant after adjusting for RSV of related terms of hand washing and social distancing as well as government policy responses represented by the Oxford COVID-19 Government Response Tracker stringency index over the same period (7) (Table E2).