EUS-guided gallbladder drainage and subsequent peroral endoscopic cholecystolithotomy: A tool to reduce chemotherapy discontinuation in neoplastic patients?

Vanella, Giuseppe; Dell’Anna, Giuseppe; Bronswijk, Michiel; Capurso, Gabriele; Reni, Michele; Falconi, Massimo; Merwe, Schalk van der; Arcidiacono, Paolo Giorgio

doi:10.1016/j.vgie.2021.10.002

Cited by 8 publications

(6 citation statements)

References 13 publications

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“…EUS-GBD may be performed fluoroless as well; in our study additional radioscopy was used for prophylactic coaxial DPPS, and resulted in a very low RE, much lower than expected for percutaneous cholecystostomy (P-GBD), which is entirely performed under radioscopic guidance. This adds to the advantages in terms of reduced acute cholecystitis recurrence 11 , and the possibility of direct endoscopic cholecystoscopy for stone clearance 12 .…”

Section: Discussionmentioning

confidence: 99%

“…Fluid collection drainage (EUS-FCD) with lumen apposing metal stents (LAMS, N = 26) were performed fluoroless, while EUS-FCD with double-pigtail plastic stents (DPPS, N = 28) required higher RE (KAP = 23 ). EUS-guided gallbladder drainage (EUS-GBD, N = 6) required scarce RE (KAP = 9 [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]) for coaxial DPPS placement. EUS-GE (N = 27) required higher RE than duodenal stenting (KAP = 44 versus 29 , P = 0.03).…”

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confidence: 99%

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Radiation exposure during modern therapeutic endoscopic ultrasound procedures and standard alternatives

et al. 2022

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Background. Therapeutic EUS (t-EUS) is increasingly adopted in clinical practice of tertiary referral centres; however, little is known about Radiation Exposure (RE) metrics and Diagnostic Reference Limits. Methods. Kerma-Area Product (KAP [Gy·cm2]), Air Kerma and Fluoroscopy Time were retrospectively evaluated for all consecutive t-EUS procedures performed in San Raffaele Institute between 2019-2021. For EUS-guided Choledochoduoenostomies (EUS-CDS) and Gastroenterostomies (EUS-GE) an equal number of ERCPs + metal stenting and Duodenal Stentings were included for comparison. Results. 141 t-EUS procedures were retrieved (49% pancreatic cancer, 38% peripancreatic fluid collections). EUS-CDS (N=44) were mainly performed fluoroless, while ERCPs required a significantly higher RE (KAP=25 [17-55], p<0.0001). Fluid collection drainage (EUS-FCD) with Lumen Apposing stents (LAMS, N=26) were performed fluoroless, while EUS-FCD with double-pigtail plastic stents (DPPS, N=28) required higher RE (KAP=23 [13-45]). EUS-guided gallbladder drainage (EUS-GBD, N=6) required scarce RE (KAP=9 [3-21]) for coaxial DPPS placement. EUS-GE (N=27) required higher RE than Duodenal Stenting (KAP=44 [28-88] versus 29 [19-46], p=0.03). EUS-guided Hepatico-Gastrostomies (EUS-HGS, N=10) had the highest RE amongst t-EUS procedures (KAP=81 [49-123]). Procedure complexity or intervening complications were evaluated and resulted in higher RE within each procedure. Conclusions. t-EUS procedures have different RE (p<0.000001). EUS-Choledochoduodenostomy, Gallbladder Drainage and Fluid Collection Drainage with LAMS can be performed with no-to-mild radioscopy, unlike standard alternatives. However, radioscopy remains essential in case of technical difficulties or complications. EUS-Gastroenterostomy and EUS-Hepaticogastrostomy involve a high RE. Endoscopists involved in t-EUS might experience a RE superior to category standards, claiming for increased awareness and personalized preventive measures.

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Section: Discussionmentioning

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Radiation exposure during modern therapeutic endoscopic ultrasound procedures and standard alternatives

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“…[ 45 ] This study, in addition to another study showing that giant residual gallbladder stones could be successfully treated by laser lithotripsy through the LAMSs,[ 46 ] suggests that patient population(s) other than those with AC may benefit from EUS-GBD. [ 47 , 48 ] This is particularly true, given aging populations, with increased numbers of fragile individuals with multiple comorbidities with gallstone disease requiring surgery. These individuals are more prone to surgically related AEs:[ 49 50 51 ] a meta-analysis including 326,517 patients undergoing elective LC demonstrated that increasing age was associated with significantly higher AEs (OR: 2.46) and rate of conversion to open cholecystectomy (OR: 1.84).…”

Section: Methodsmentioning

confidence: 99%

“…[ 44 ] Scheduled endoscopic stone clearance (cholecystolithotomy) and LAMS exchange for DPPSs are thought to potentially reduce long-term AC recurrence and stent-related trauma, but additional prospective data are needed. [ 48 ]…”

Section: Methodsmentioning

confidence: 99%

Current landscape of therapeutic EUS: Changing paradigms in gastroenterology practice

Arcidiacono

Merwe

Vanella

et al. 2022

Endoscopic Ultrasound

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Therapeutic EUS has witnessed exponential growth in the last decade, but it has been considered investigational until recently. An increasing body of good-quality evidence is now demonstrating clear advantages over established alternatives, adding therapeutic EUS to management algorithms of complex hepato-pancreato-biliary (HPB) and gastrointestinal (GI) conditions. In this review, the available evidence and clinical role of therapeutic EUS in established and evolving applications will be discussed. A Graphical Summary for each scenario will provide (1) technical steps, (2) anatomical sketch, (3) best-supporting evidence, and (4) role in changing current and future GI practice. Therapeutic EUS has accepted well-established applications such as drainage of symptomatic peripancreatic fluid collections, biliary drainage in failed endoscopic retrograde cholangiopancreatography, and treatment of acute cholecystitis in unfit-for-surgery patients. In addition, good-quality evidence on several emerging indications (e.g., treatment of gastric outlet obstruction, local ablation of pancreatic solid lesions, etc.) is promising. Specific emphasis will be given to how these technical innovations have changed management paradigms and algorithms and expanded the possibilities of gastroenterologists to provide therapeutic solutions to old and emerging clinical needs. Therapeutic EUS is cementing its role in everyday practice, radically changing the treatment of different HPB diseases and other conditions (e.g., GI obstruction). The development of dedicated accessories and increased training opportunities will How to cite this article:

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“…ESGE guidelines suggest that therapeutic EUS should be performed by experienced endoscopists, trained in both EUS and ERCP [ 14 ], as many of these procedures require proficiency in EUS as well as guidewire handling and cannulation, cholangiography interpretation and biliary stenting. This allows EUS-BD to be performed as a rescue strategy immediately after failed/impossible ERCP during the same session, potentially preventing therapeutic delay, reducing hospital stay and facilitating early chemotherapy resumption [ 25 ]. Moreover, this can assure a prompt management of eventual intraprocedural complications (such as stent misdeployment).…”

Section: Introductionmentioning

confidence: 99%

Endoscopic ultrasound-guided biliary drainage and gastrointestinal anastomoses: the journey from promising innovations to standard of care

Vanella

Dell’Anna

Bronswijk

et al. 2022

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Biliary obstruction (BO) and gastric outlet obstruction (GOO) are frequent complications of pancreatobiliary and gastroduodenal neoplasia, which can severely impact oncological outcomes, patient survival and quality of life. Although endoscopic retrograde cholangiopancreatography (ERCP) remains the gold standard for biliary drainage, this may fail or be unfeasible because of duodenal/papillary infiltration or surgically-altered anatomy. Percutaneous transhepatic biliary drainage (PTBD) has been the standard rescue therapy in this setting, but is burdened by high morbidity and reduced quality of life. As for GOO, surgical gastroenterostomy and enteral stenting are limited by invasiveness and suboptimal long-term outcomes, respectively. Endoscopic ultrasound (EUS) has evolved from a diagnostic to a therapeutic modality, providing a safe and effective alternative for draining the pancreatobiliary tract into the stomach or duodenum. EUS-guided biliary drainage (EUS-BD) has already demonstrated similar efficacy, greater safety and fewer reinterventions compared to PTBD, and can be performed in the same session after ERCP failure. Further development of lumen apposing metal stents has paved the way towards the creation of EUS-guided anastomoses. EUS-guided gastroenterostomy (EUS-GE) is nowadays increasingly used to treat GOO, combining the minimal invasiveness of endoscopy with surgical-range efficacy. This review summarizes the technical details, current evidence and society recommendations contributing to EUS-BD and EUS-GE gaining ground in everyday practice or tertiary referral centers and becoming crucial in improving the multidisciplinary management of cancer-related symptoms.

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EUS-guided gallbladder drainage and subsequent peroral endoscopic cholecystolithotomy: A tool to reduce chemotherapy discontinuation in neoplastic patients?

Cited by 8 publications

References 13 publications

Radiation exposure during modern therapeutic endoscopic ultrasound procedures and standard alternatives

Radiation exposure during modern therapeutic endoscopic ultrasound procedures and standard alternatives

Current landscape of therapeutic EUS: Changing paradigms in gastroenterology practice

Endoscopic ultrasound-guided biliary drainage and gastrointestinal anastomoses: the journey from promising innovations to standard of care

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