Endoscopic ultrasound-guided placement of the lumen-apposing self-expandable metallic stent for gallbladder drainage: a promising technique

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.

Endoscopic Ultrasonography (EUS) and Gallbladder

“…EUS-GBD is recently gaining favor as an attractive alternative approach for management of acute cholecystitis in high-risk surgical patients [5,46]. EUS-GBD has been performed by using plastic stents, nasobiliary catheters, covered self-expandable metal stents, and, most recently, lumen-apposing metal stents (LAMSs).…”

“…Finally, EUS-guided gallbladder drainage (EUS-GBD) is recently gaining favor as an attractive alternative for managing acute cholecystitis in highrisk patients. The advantages of EUS-GBD are the avoidance of external drainage (unlike percutaneous transhepatic gallbladder drainage) and the potential for no risk of post-ERCP (endoscopic retrograde cholangiopancreatography) pancreatitis or cholangitis (unlike transpapillary drainage) [5,6].…”

EUS-guided cholecystogastrostomy for acute cholecystitis in a patient with an omphalocele

“…Percutaneous cholecystostomy tubes can cause discomfort and pain, leading to a decreased quality of life with the possibility of a lifelong indwelling tube. 3 In patients with a complex abdominal wall due to a partially repaired omphalocele, who require long-term gallbladder decompression, we believe that EUS-guided cholecystogastrostomy with the use of a lumenapposing metal stent (LAMS) offers a minimally invasive approach that achieves long-term drainage and also maximizes quality of life. Thus, the patient was referred for endoscopic drainage.…”

“…3; Video 1, available online at www.VideoGIE.org). 3 After deployment, the stent was dilated to 6 mm, resulting in purulent drainage. A 10F Â 4-cm double-pigtail plastic stent was placed across the LAMS.…”

The future of ERCP

“…I once referred to these as the salt and pepper shakers of pancreatobiliary disease although knife and fork imagery is probably more apropos. As an individual who trained long before the introduction of EUS, I nevertheless believe that the 2 skillsets are complementary and that practicing ERCP alone limits both new diagnostic and therapeutic options and may result in overutilization of one of the higher-risk procedures that we do in therapeutic endoscopy 17 18 19 20 21 22 23 24 25.…”