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EUS-Guided Gallbladder Drainage

  • Sunil Amin
  • Amrita SethiEmail author
Chapter

Abstract

High-risk non-surgical candidates with acute cholecystitis are traditionally treated with the placement of a percutaneous cholecystostomy tube. However, in recent years, transmural gallbladder drainage via an endoscopic ultrasound-guided approach (EUS-GBD) has emerged as a feasible and potential equally efficacious option that obviates the need for an external drainage catheter. Among expert endoscopists, technical and clinical success rates for EUS-GBD are greater than 90% with similar adverse event rates to percutaneous drainage. Early adopters of EUS-GBD used plastic or fully covered metal self-expandable metal biliary stents (FCSEMS), but more recently, the use of a lumen-apposing metal stent (LAMS) has become widespread due to ease of deployment and lower concern for biliary leakage. Furthermore, LAMS provides continued access to the gallbladder for cholecystoscopy or other advanced interventions such as stone removal. Nevertheless, EUS-GBD remains a relatively new procedure and optimal techniques and best practices are still being defined. As such, endoscopists have yet to reach consensus on issues such as optimal location of drainage (transgastric vs. transduodenal), ideal duration for stents to be left in, and whether patients should receive routine cholecystectomy after resolution of symptoms. Until prospective trials address these issues, EUS-GBD should only be reserved for carefully selected patients in tertiary care centers.

Keywords

Endoscopic ultrasonography Acute cholecystitis EUS-GB Lumen-apposing metal stent Drainage Percutaneous 

Supplementary material

Video 4.1

Narrated video demonstrating EUS-guided GBD with 15 mm ECE-AXIOS stent using free-hand technique. Courtesy of Mouen Khashab, MD (MP4 153938 kb)

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Division of Gastroenterology and HepatologyVirginia Mason Medical CenterSeattleUSA
  2. 2.Division of Digestive and Liver DiseasesColumbia University Medical CenterNew YorkUSA

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