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Feasibility and safety of endoscopic ultrasound-guided gallbladder drainage using a newly designed lumen-apposing metal stent

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Abstract

Background and aims

Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is increasingly accepted as an effective treatment option in patients who require drainage for acute cholecystitis. A newly designed lumen-apposing metal stent (LAMS) has been introduced recently in this procedure. In this study, we evaluated the feasibility and safety of the newly designed LAMS in patients with acute cholecystitis who were unsuitable for cholecystectomy.

Methods

Between Mar 2017 and Oct 2017, 22 patients with acute cholecystitis who were unsuitable for cholecystectomy underwent EUS-GBD with the newly designed LAMS. We evaluated the technical and clinical success and the adverse event profiles.

Results

EUS-GBD with newly designed LAMS was technically and clinically successful in 21 of the 22 patients. EUS-GB stenting was performed at urgent setting in 17 patients, while 5 patients, who had undergone initial PTGBD, underwent EUS-GB stenting to remove PTGBD tube. The median procedure time was 11.5 (range 8.8–17.0) min. A late adverse event of stent occlusion developed in one patient. Stent migration was not observed during follow-up (median 318.0 days, range 39.0–398.0 days) and cumulative stent patency rate at 1 year was 95%.

Conclusion

EUS-GBD with newly designed LAMS is feasible and shows acceptable safety profiles for both the urgent drainage of acute cholecystitis and elective internalization following PTGBD in patients with high surgical risk.

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Abbreviations

PTGBD:

Percutaneous transhepatic gallbladder drainage

EUS-GBD:

Endoscopic ultrasound-guided gallbladder drainage

LAMS:

Lumen-apposing metal stent

ASA:

American Society of Anesthesiologists

SD:

Standard deviation

IQR:

Interquartile range

CI:

Confidence interval

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Authors and Affiliations

  1. Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea

    Dong Hui Cho, Seok Jung Jo, Tae Jun Song, Do Hyun Park, Sung Koo Lee, Myung-Hwan Kim & Sang Soo Lee

  2. Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea

    Jae Hoon Lee

Authors
  1. Dong Hui Cho
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  2. Seok Jung Jo
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  6. Sung Koo Lee
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  7. Myung-Hwan Kim
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Contributions

DHC were responsible for the conception and design of the study; generation, collection, assembly, analysis, and interpretation of data; and drafting of the manuscript. SSL was responsible for the conception and design of the study; generation, collection, assembly, analysis, and interpretation of data; revision of the manuscript; and approval of the final version of the manuscript. SJJ, JHL, TJS, DHP, SKL, M-HK were responsible for the collection and analysis of data and revision of the manuscript.

Corresponding author

Correspondence to Sang Soo Lee.

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Disclosures

Drs. Dong Hui Cho, Seok Jung Jo, Jae Hoon Lee, Tae Jun Song, Do Hyun Park, Sung Koo Lee, Myung-Hwan Kim, and Sang Soo Lee have no conflicts of interest or financial ties to disclose.

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Cho, D.H., Jo, S.J., Lee, J.H. et al. Feasibility and safety of endoscopic ultrasound-guided gallbladder drainage using a newly designed lumen-apposing metal stent. Surg Endosc 33, 2135–2141 (2019). https://doi.org/10.1007/s00464-018-6485-5

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  • DOI: https://doi.org/10.1007/s00464-018-6485-5

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