Endoscopic ultrasound guided gallbladder drainage by using Lumen apposing metal stent for acute cholecystitis: systematic review
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Surgery remains the standard treatment for acute cholecystitis except in high-risk candidates where percutaneous transhepatic gallbladderdrainage (PT-GBD), endoscopic transpapillary cystic duct stenting (ET-CDS), and endoscopic ultrasound-guided gallbladder drainage(EUS-GBD) are potential choices. PT-GBD is contraindicated in patients with coagulopathy or ascites and is not preferred by patientsowing to aesthetic reasons. ET-CDS is successful only if the cystic duct can be visualized and cannulated. For 189 patients whounderwent EUS-GBD via insertion of a lumen-apposing metal stent (LAMS), the composite technical success rate was 95.2%, which increasedto 96.8% when LAMS was combined with co-axial self-expandable metal stent (SEMS). The composite clinical success rate was96.7%. We observed a small risk of recurrent cholecystitis (5.1%), gastrointestinal bleeding (2.6%) and stent migration (1.1%). Cauteryenhanced LAMS significantly decreases the stent deployment time compared to non-cautery enhanced LAMS. Prophylactic placementof a pigtail stent or SEMS through the LAMS avoids re-interventions, particularly in patients, where it is intended to remain in situ indefinitely. Limited evidence suggests that the effcacy of EUS-GBD via LAMS is comparable to that of PT-GBD with the former showingbetter results in postoperative pain, length of hospitalization, and need for antibiotics. EUS-GBD via LAMS is a safe and effcaciousoption when performed by experts.
Abstract
Surgery remains the standard treatment for acute cholecystitis except in high-risk candidates where percutaneous transhepatic gallbladderdrainage (PT-GBD), endoscopic transpapillary cystic duct stenting (ET-CDS), and endoscopic ultrasound-guided gallbladder drainage(EUS-GBD) are potential choices. PT-GBD is contraindicated in patients with coagulopathy or ascites and is not preferred by patientsowing to aesthetic reasons. ET-CDS is successful only if the cystic duct can be visualized and cannulated. For 189 patients whounderwent EUS-GBD via insertion of a lumen-apposing metal stent (LAMS), the composite technical success rate was 95.2%, which increasedto 96.8% when LAMS was combined with co-axial self-expandable metal stent (SEMS). The composite clinical success rate was96.7%. We observed a small risk of recurrent cholecystitis (5.1%), gastrointestinal bleeding (2.6%) and stent migration (1.1%). Cauteryenhanced LAMS significantly decreases the stent deployment time compared to non-cautery enhanced LAMS. Prophylactic placementof a pigtail stent or SEMS through the LAMS avoids re-interventions, particularly in patients, where it is intended to remain in situ indefinitely. Limited evidence suggests that the effcacy of EUS-GBD via LAMS is comparable to that of PT-GBD with the former showingbetter results in postoperative pain, length of hospitalization, and need for antibiotics. EUS-GBD via LAMS is a safe and effcaciousoption when performed by experts.
참고문헌 (17)
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