Similar Efficacies of Endoscopic Ultrasound Gallbladder Drainage With a Lumen-Apposing Metal Stent Versus Percutaneous Transhepatic Gallbladder Drainage for Acute Cholecystitis

Background A novel self‐approximating lumen‐apposing metallic stent (LAMS; Niti‐S Spaxus, Taewoong Medical, Gyeonggi‐do, Korea) has recently become available. The aim of the present study was to evaluate the outcomes for drainage of pancreatic fluid collections (PFC). Methods This was a prospective international multicentered study conducted in six high‐volume institutions across Asia. Consecutive patients suffering from pancreatic pseudocyst or walled‐off pancreatic necrosis (WOPN) requiring endoscopic ultrasonography‐guided drainage were recruited. Outcomes included technical and clinical success, adverse events, procedural events, interventions through the stent and recurrence rates. Results Between August 2016 and November 2017, 59 patients were recruited to this study. Thirty‐nine patients (66.1%) had WOPN and mean (SD) size of PFC was 11.5 (5.1) cm. Technical and clinical success rates were 100%. Mean (SD) procedural time was 35.0 (17.2) minutes. Sixteen‐millimeter stents were used in 66.1% of the patients. Fifty‐four sessions of necrosectomy were carried out with the stent in situ in 17 patients. Stent‐related adverse event (AE) rate was 6.8%. Three patients (5.1%) suffered from bleeding after stenting and one required angiographic embolization. Two patients (3.4%) suffered from recurrence during a mean (SD) follow‐up time of 325.6 (355.5) days. There were no differences in outcomes between those with pseudocysts or WOPN except for the duration of hospital stay (P = 0.012). Conclusion Use of a self‐approximating LAMS for drainage of PFC was safe and effective. Endoscopic necrosectomy could be carried out through the stent with ease. The device was associated with a low rate of stent‐related AE.

Section: Discussionmentioning

confidence: 99%

Prospective multicenter international study on the outcomes of a newly developed self‐approximating lumen‐apposing metallic stent for drainage of pancreatic fluid collections and endoscopic necrosectomy

Teoh

Bapaye

Lakhtakia

et al. 2019

“…Bile leakage and peritonitis have been attributed to an anatomic gap between the gallbladder and gastrointestinal lumen, leaving a potential route for infected bile to leak into the abdominal cavity during gallbladder puncture and dilation of the puncture site. One approach to limit this risk has been using the LAMS as a sealed transmural conduit between the gallbladder and gastrointestinal tract . However, LAMS are considerably more expensive than plastic stents and are not widely available in Japan.…”

Section: Discussionmentioning

confidence: 99%

“…One approach to limit this risk has been using the LAMS as a sealed transmural conduit between the gallbladder and gastrointestinal tract. [29][30][31][32] However, LAMS are considerably more expensive than plastic stents and are not widely available in Japan.…”

Section: Discussionmentioning

confidence: 99%

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Clinical efficacy and safety of endoscopic ultrasound‐guided gallbladder drainage replacement of percutaneous drainage: A multicenter retrospective study

Minaga

Yamashita²,

Ogura

et al. 2018

“…Recently, endoscopic ultrasound (EUS)‐guided transluminal drainage techniques have been developed for managing a variety of conditions, such as hepaticogastrostomy (HGS), pseudocyst drainage, pancreaticogastrostomy, and choledochoduodenostomy (CDS) . More recently, EUS‐guided gallbladder drainage (EUS‐GBD) is increasingly being carried out as an alternative method to PTGBD and ETGBD …”

Section: Introductionmentioning

confidence: 99%

Endoscopic ultrasound‐guided gallbladder drainage: Current status and future prospects

Ogura

Higuchi

2019

Early surgical treatment using the laparoscopic approach is generally accepted as the treatment of choice for acute cholecystitis (AC) according to Tokyo Guidelines 2018 (TG2018). If the patient is a poor candidate for surgery because of the presence of advanced malignancy or severe organ failure, this treatment may be too invasive. In such cases, gallbladder drainage is considered an alternative treatment method to surgery. Several drainage methods have been established, such as percutaneous transhepatic gallbladder drainage (PTGBD) or endoscopic transpapillary gallbladder drainage (ETGBD) under endoscopic retrograde cholangiopancreatography (ERCP), including endoscopic naso‐gallbladder drainage (ENGBD) and endoscopic gallbladder stenting (EGBS). PTGBD is a well‐established procedure that is relatively easily carried out by general clinicians. And ETGBD has been developed as an alternative drainage method. The procedure also calls for guidewire passage across the cystic duct. Therefore, in AC cases who are contraindicated for surgery, PTGBD should be considered before ETGBD, and ETGBD may be considered only in high‐volume institutes where expert hands are available, as described in the TG2018. However, there are several limitations to these procedures. Recently, endoscopic ultrasound‐guided gallbladder drainage (EUS‐GBD) is increasingly being done as an alternative method to PTGBD and ETGBD. In this review, the current status and problems of EUS‐GBD are reviewed, including technical review and clinical data of previous papers, current indication, long‐term outcome, and comparison data with PTGBD or ETGBD, and their future prospects are discussed.