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Shayan Irani - One of the best experts on this subject based on the ideXlab platform.
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endoscopic ultrasound guided Gallbladder Drainage as a rescue therapy for unresectable malignant biliary obstruction a multicenter experience
Endoscopy, 2020Co-Authors: Danny Issa, Ryan Law, Shayan Irani, Shawn L Shah, Sean Bhalla, Srihari Mahadev, Kaveh Hajifathalian, Kartik Sampath, Saurabh Mukewar, David L CarrlockeAbstract:Background Endoscopic retrograde cholangiopancreatography (ERCP) is often unsuccessful in patients with duodenal stenosis or malignant ampullary infiltration. While endoscopic ultrasound-guided biliary Drainage (EUS-BD) has been proposed as an alternative, EUS-guided Gallbladder Drainage (EUS-GBD) is an attractive option when both approaches fail. We aimed to assess the effectiveness and safety of EUS-GBD as rescue therapy for malignant distal bile duct obstruction. Methods A multicenter retrospective study was performed on patients with unresectable malignant distal bile duct obstruction who underwent EUS-GBD between 2014 and 2019 after unsuccessful ERCP and EUS-BD. Clinical success was defined as a decrease in serum bilirubin of > 50 % within 2 weeks. Results 28 patients were included, with a lumen-apposing metal stent used in 26 (93 %) and a self-expandable metal stent in two (7 %). The technical success rate was 100 %. The clinical success rate was 93 %, with an improvement in bilirubin (7.3 [SD 5.4] pre-procedure vs. 2.8 [SD 1.1] post-procedure; P = 0.001). Delayed adverse events included food impaction of the stent (n = 3), with a further two patients developing cholecystitis and bleeding. Conclusion This study demonstrates the feasibility of Gallbladder Drainage to relieve malignant distal bile duct obstruction in patients with failed ERCP and EUS-BD.
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eus guided versus endoscopic transpapillary Gallbladder Drainage in high risk surgical patients with acute cholecystitis a systematic review and meta analysis
Surgical Endoscopy and Other Interventional Techniques, 2020Co-Authors: Rajesh Krishnamoorthi, Michael C Larsen, Mahendran Jayaraj, Viveksandeep Thoguluva Chandrasekar, Dhruv P Singh, Joanna Law, Andrew S Ross, Richard A Kozarek, Shayan IraniAbstract:In patients with acute cholecystitis who are deemed high risk for cholecystectomy, percutaneous cholecystostomy (PC) was historically performed for Gallbladder Drainage (GBD). There are several limitations associated with PC. Endoscopic GBD [Endoscopic transpapillary GBD (ET-GBD) and EUS-guided GBD (EUS-GBD)] is an alternative to PC. We performed a systematic review and meta-analysis to compare the effectiveness and safety of EUS-GBD versus ET-GBD. We performed a systematic search of multiple databases through May 2019 to identify studies that compared outcomes of EUS-GBD versus ET-GBD in the management of acute cholecystitis in high-risk surgical patients. Pooled odds ratios (OR) of technical success, clinical success and adverse events between EUS-GBD and ET-GBD groups were calculated. Five studies with a total of 857 patients (EUS-GBD vs ET-GBD: 259 vs 598 patients) were included in the analysis. EUS-GBD was associated with higher technical [pooled OR 5.22 (95% CI 2.03–13.44; p = 0.0006; I2 = 20%)] and clinical success [pooled OR 4.16 (95% CI 2.00–8.66; p = 0.0001; I2 = 19%)] compared to ET-GBD. There was no statistically significant difference in the rate of overall adverse events [pooled OR 1.30 (95% CI 0.77–2.22; p = 0.33, I2 = 0%)]. EUS-GBD was associated with lower rate of recurrent cholecystitis [pooled OR 0.33 (95% CI 0.14–0.79; p = 0.01; I2 = 0%)]. There was low heterogeneity in the analyses. EUS-GBD has higher rate of technical and clinical success compared to ET-GBD. While the rates of overall adverse events are statistically similar, EUS-GBD has lower rate of recurrent cholecystitis. Hence, EUS-GBD is preferable to ET-GBD for endoscopic management of acute cholecystitis in select high-risk surgical patients.
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eus guided Gallbladder Drainage with a lumen apposing metal stent versus endoscopic transpapillary Gallbladder Drainage for the treatment of acute cholecystitis with videos
Gastrointestinal Endoscopy, 2019Co-Authors: Jennifer T Higa, Michael C Larsen, Andrew S Ross, Richard A Kozarek, Nadav Sahar, Danielle La Selva, Sengian Gan, Shayan IraniAbstract:Background and Aims There is an evolving role for EUS-guided transmural Gallbladder (GB) Drainage. Endoscopic transpapillary GB Drainage is a well-established, nonoperative treatment for acute cholecystitis. We compared the outcomes of 78 cases of EUS-guided versus transpapillary GB Drainage at a single, U.S.-based, high-volume endoscopy center. Methods This was a retrospective analysis performed from May 2013 to January 2018, identified from a database of nonoperative patients with acute cholecystitis. Both electrocautery-enhanced and nonelectrocautery-enhanced lumen-apposing metal stents were used. For transpapillary Drainage, guidewire access was obtained and then a transpapillary 7F × 15-cm double-pigtail plastic stent was placed. Results In patients who had successful transpapillary or transmural Drainage, demographics data were similar. Technical success was observed in 39 of 40 patients (97.5%) who underwent first attempt at EUS-guided Drainage versus 32 of 38 patients (84.2%) for first-attempt transpapillary Drainage (adjusted odds ratio, 9.83; 95% confidence interval, .93-103.86). Clinical success was significantly higher with EUS Drainage in 38 of 40 patients (95.0%) versus transpapillary Drainage in 29 of 38 patients (76.3%) (adjusted odds ratio, 7.14; 95% confidence interval, 1.32-38.52). Recurrent cholecystitis was lower in the EUS-guided Drainage group (2.6% vs 18.8%, respectively; P = .023) on univariate analysis but only trended to significance in a multiple regression model. Duration of follow-up, reintervention rates, hospital length of stay, and overall adverse event rates were similar between groups. Conclusions EUS-guided GB Drainage results in a higher clinical success rate compared with transpapillary Drainage and may be associated with a lower recurrence rate of cholecystitis. However, transpapillary Drainage should be considered as the first-line treatment for patients who are surgical candidates but require temporizing measures or require an ERCP for alternative reasons.
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outcomes of an international multicenter registry on eus guided Gallbladder Drainage in patients at high risk for cholecystectomy
Endoscopy International Open, 2019Co-Authors: Anthony Yuen Bun Teoh, Manuel Perezmiranda, Todd H Baron, Rastislav Kunda, Sang Soo Lee, Shayan Irani, Paul Yeaton, Siyu Sun, Jong Ho Moon, Bronte A HoltAbstract:Background and study aims The aim of the current study was to review the outcomes of a large-scale international registry on endoscopic ultrasound-guided Gallbladder Drainage (EGBD) that encompasses different stent systems in patients who are at high-risk for cholecystectomy. Patients and methods This was a retrospective international multicenter registry on EGBD created by 13 institutions around the world. Consecutive patients who received EGBD for several indications were included. Outcomes include technical and clinical success, unplanned procedural events (UPE), adverse events (AEs), mortality, recurrent cholecystitis and learning curve of the procedure. Results Between June 2011 and November 2017, 379 patients were recruited to the study. Technical and clinical success were achieved in 95.3 % and 90.8 % of the patients, respectively. The 30-day AE rate was 15.3 % and 30-day mortality was 9.2 %. UPEs were significantly more common in patients with EGBD performed for conversion of cholecystostomy and symptomatic gallstones (P Conclusion EGBD was associated with high success rates in this large-scale study. EGBD performed for indications other than acute cholecystitis was associated with higher UPEs. The number of cases required to gain competency with the technique by experienced interventional endosonographers was 25 procedures.
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endoscopic ultrasound guided Gallbladder Drainage versus percutaneous cholecystostomy for high risk surgical patients with acute cholecystitis a systematic review and meta analysis
Endoscopy, 2019Co-Authors: Sally W Luk, James Y W Lau, Shayan Irani, Rajesh Krishnamoorthi, Anthony Yuenbum TeohAbstract:Background Recent evidence suggests that endoscopic ultrasound-guided Gallbladder Drainage (EUS-GBD) is an effective and safe alternative to percutaneous Drainage (PT-GBD). We conducted a systematic review and meta-analysis to compare these two procedures in high risk surgical patients with acute cholecystitis. Methods A comprehensive electronic literature search was conducted for all articles published up to October 2017 to identify comparative studies between EUS-GBD and PT-GBD. A meta-analysis was performed on outcomes including technical success, clinical success, post-procedure adverse events, length of hospital stay, unplanned hospital readmission, need for reintervention, recurrent cholecystitis, and disease- or treatment-related mortality for these two procedures. Results Five comparative studies (206 patients in the EUS-GBD group vs. 289 patients in the PT-GBD group), were included in the final analysis. There were no statistically significant differences in technical success (odds ratio [OR] 0.43, 95 % confidence interval [CI] 0.12 to 1.58; P = 0.21; I 2 = 0 %) and clinical success (OR 1.07, 95 %CI 0.36 to 3.16; P = 0.90; I 2 = 44 %) between the two procedures. EUS-GBD had fewer adverse events than PT-GBD (OR 0.43, 95 %CI 0.18 to 1.00; P = 0.05; I 2 = 66 %). Moreover, patients undergoing EUS-GBD had shorter hospital stays, with pooled standard mean difference of – 2.53 (95 %CI – 4.28 to – 0.78; P = 0.005; I 2 = 98 %), and required significantly fewer reinterventions (OR 0.16, 95 %CI 0.04 to 0.042; P < 0.001; I 2 = 32 %) resulting in significantly fewer unplanned readmissions (OR 0.16, 95 %CI 0.05 to 0.53; P = 0.003; I 2 = 79 %). Conclusions EUS-GBD was associated with lower rates of post-procedure adverse events, shorter hospital stays, and fewer reinterventions and readmissions compared with PT-GBD in patients with acute cholecystitis who were unfit for surgery.
Todd H Baron - One of the best experts on this subject based on the ideXlab platform.
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outcomes of an international multicenter registry on eus guided Gallbladder Drainage in patients at high risk for cholecystectomy
Endoscopy International Open, 2019Co-Authors: Anthony Yuen Bun Teoh, Manuel Perezmiranda, Todd H Baron, Rastislav Kunda, Sang Soo Lee, Shayan Irani, Paul Yeaton, Siyu Sun, Jong Ho Moon, Bronte A HoltAbstract:Background and study aims The aim of the current study was to review the outcomes of a large-scale international registry on endoscopic ultrasound-guided Gallbladder Drainage (EGBD) that encompasses different stent systems in patients who are at high-risk for cholecystectomy. Patients and methods This was a retrospective international multicenter registry on EGBD created by 13 institutions around the world. Consecutive patients who received EGBD for several indications were included. Outcomes include technical and clinical success, unplanned procedural events (UPE), adverse events (AEs), mortality, recurrent cholecystitis and learning curve of the procedure. Results Between June 2011 and November 2017, 379 patients were recruited to the study. Technical and clinical success were achieved in 95.3 % and 90.8 % of the patients, respectively. The 30-day AE rate was 15.3 % and 30-day mortality was 9.2 %. UPEs were significantly more common in patients with EGBD performed for conversion of cholecystostomy and symptomatic gallstones (P Conclusion EGBD was associated with high success rates in this large-scale study. EGBD performed for indications other than acute cholecystitis was associated with higher UPEs. The number of cases required to gain competency with the technique by experienced interventional endosonographers was 25 procedures.
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tokyo guidelines 2018 management strategies for Gallbladder Drainage in patients with acute cholecystitis with videos
Journal of Hepato-biliary-pancreatic Sciences, 2018Co-Authors: Yasuhisa Mori, Steven M. Strasberg, Henry A. Pitt, Todd H Baron, Tadahiro Takada, Takao Itoi, Tomohiko Ukai, Satoru Shikata, Yoshinori Noguchi, Anthony Y TeohAbstract:Since the publication of the Tokyo Guidelines in 2007 and their revision in 2013, appropriate management for acute cholecystitis has been more clearly established. Since the last revision, several manuscripts, especially for alternative endoscopic techniques, have been reported; therefore, additional evaluation and refinement of the 2013 Guidelines is required. We describe a standard Drainage method for surgically high-risk patients with acute cholecystitis and the latest developed endoscopic Gallbladder Drainage techniques described in the updated Tokyo Guidelines 2018 (TG18). Our study confirmed that percutaneous transhepatic Gallbladder Drainage should be considered the first alternative to surgical intervention in surgically high-risk patients with acute cholecystitis. Also, endoscopic transpapillary Gallbladder Drainage or endoscopic ultrasound-guided Gallbladder Drainage can be considered in high-volume institutes by skilled endoscopists. In the endoscopic transpapillary approach, either endoscopic naso-Gallbladder Drainage or Gallbladder stenting can be considered for Gallbladder Drainage. We also introduce special techniques and the latest outcomes of endoscopic ultrasound-guided Gallbladder Drainage studies. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.
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efficacy and safety of endoscopic Gallbladder Drainage in acute cholecystitis is it better than percutaneous Gallbladder Drainage
Gastrointestinal Endoscopy, 2017Co-Authors: Muhammad Ali Khan, Omair Atiq, Nisa Kubiliun, Bilal Ali, Faisal Kamal, Richard Nollan, Mohammad K Ismail, Claudio Tombazzi, Michel Kahaleh, Todd H BaronAbstract:Background and Aims The efficacy and safety of endoscopic Gallbladder Drainage (EGBD) performed via endoscopic retrograde cholangiography (ERC)-based transpapillary stenting or EUS-based transmural stenting are unknown. We aimed to conduct a proportion meta-analysis to evaluate the cumulative efficacy and safety of these procedures and to compare them with percutaneous Gallbladder Drainage (PGBD). Methods We searched several databases from inception through December 10, 2015 to identify studies (with 10 or more patients) reporting technical success and postprocedure adverse events of EGBD. Weighted pooled rates (WPRs) for technical and clinical success, postprocedure adverse events, and recurrent cholecystitis were calculated for both methods of EGBD. Pooled odds ratios (ORs) were also calculated to compare the technical success and postprocedure adverse events in patients undergoing EGBD versus PGBD. Results The WPRs with 95% confidence intervals (CIs) of technical success, clinical success, postprocedure adverse events, and recurrent cholecystitis for ERC-based transpapillary Drainage were 83% (95% CI, 78%-87%; I 2 = 38%), 93% (95% CI, 89%-96%; I 2 = 39%), 10% (95% CI, 7%-13%; I 2 = 27%), and 3% (95% CI, 1%-5%; I 2 = 0%), respectively. The WPRs for EUS-based Drainage for technical success, clinical success, postprocedure adverse events, and recurrent cholecystitis were 93% (95% CI, 87%-96%; I 2 = 0%), 97% (95% CI, 93%-99%; I 2 = 0%), 13% (95% CI, 8%-19%; I 2 = 0%), and 4% (95% CI, 2%-9%; I 2 = 0%), respectively. On proportionate difference, EUS-based Drainage had better technical (10%) and clinical success (4%) in comparison with ERC-based Drainage. The pooled OR for technical success of EGBD versus PGBD was .51 (95% CI, .09-2.88; I 2 = 23%) and for postprocedure adverse events was .33 (95% CI, .14-.80; I 2 = 16%) in favor of EGBD. Conclusions EGBD is an efficacious and safe therapeutic modality for treatment of patients with acute cholecystitis who cannot undergo surgery. EGBD shows a similar technical success as PGBD but appears to be safer than PGBD.
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conversion of percutaneous cholecystostomy to internal transmural Gallbladder Drainage using an endoscopic ultrasound guided lumen apposing metal stent
Clinical Gastroenterology and Hepatology, 2016Co-Authors: Ryan Law, Ian S Grimm, Joseph M Stavas, Todd H BaronAbstract:Patients with acute cholecystitis sometimes require placement of percutaneous cholecystostomy catheters, either as a bridge to surgery or as primary therapy. In patients who cannot undergo surgery, subsequent removal of the catheter can lead to recurrence of cholecystitis, whereas leaving the drain in place can cause adverse events. We investigated internalization of percutaneous cholecystostomy Drainage catheters, using endoscopic ultrasound (EUS)-guided placement of lumen-apposing metal stents (LAMS) as an alternative treatment strategy. Seven patients (median age, 57 years; 6 men) underwent EUS-guided cholecystoenterostomy for internalization of Gallbladder Drainage with EUS-guided placement of a 10- or 15-mm LAMS. All had initially been treated with placement of a percutaneous cholecystostomy catheter for cholecystitis and were later deemed unfit for cholecystectomy. Technical success was achieved in all patients in 1 endoscopic session, with subsequent removal of all percutaneous drains. Two patients required placement of self-expandable metal stents within the LAMS to successfully bridge the Gallbladder and gastrointestinal lumen. No adverse events occurred after a median follow-up of 2.5 months. EUS-guided cholecystoenterostomy using a LAMS is therefore a viable option for internal Gallbladder Drainage in patients who have a percutaneous cholecystostomy catheter and are poor candidates for cholecystectomy.
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eus guided Gallbladder Drainage with a lumen apposing metal stent with video
Gastrointestinal Endoscopy, 2015Co-Authors: Shayan Irani, Ian S Grimm, Todd H Baron, Mouen A KhashabAbstract:Background and Aims Nonsurgical techniques for Gallbladder Drainage are percutaneous, and endoscopic. EUS-guided transmural Gallbladder Drainage (EUS-GBD) is a relatively new approach, although data are limited. Our aim was to describe the outcome after EUS-GBD with a lumen-apposing metal stent (LAMS). Patients and Methods This was a retrospective review of prospectively collected data on 15 nonsurgical patients who underwent EUS-GBD for various indications. Procedures were performed at 3 tertiary care centers with expertise in the management of complex biliary problems. The main outcome measures were technical and clinical success and adverse events. Results Fifteen patients (8 male, 7 female) with a median age of 74 years (range 42-89) underwent EUS-GBD by using a LAMS to decompress the Gallbladder (7 patients calculous cholecystitis, 4 acalculous cholecystitis, 2 patients biliary obstruction, 1 patient Gallbladder hydrops, 1 patient symptomatic cholelithiasis). Patients were nonsurgical candidates according to the American Society of Anesthesiologists Physical Status Classification System; findings were class IV or higher in 9 patients and advanced malignancies in 6. Percutaneous transhepatic Gallbladder Drainage (PT-GBD) was refused by all patients and was further precluded by perihepatic ascites in 3 patients, coagulopathy or need for anticoagulation in 4 patients, and need for internal biliary Drainage in 2 patients. Transduodenal access and stenting was achieved in 14 of 15 patients and transgastric stenting was achieved in 1. Technical success was achieved in 14 of 15 patients (93%), whereas clinical success was achieved in all 15 patients with a median follow-up of 160 days. One mild adverse event (postprocedure fever for 3 days) was noted. The limitations of this study are the small select group of patients and retrospective study design. Conclusions EUS-GBD with a LAMS is technically safe and effective for decompressing the Gallbladder for cholecystitis and biliary or cystic duct obstruction in patients who are poor surgical candidates.
Myunghwan Kim - One of the best experts on this subject based on the ideXlab platform.
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comparison of the effectiveness and safety of lumen apposing metal stents and anti migrating tubular self expandable metal stents for eus guided Gallbladder Drainage in high surgical risk patients with acute cholecystitis
Gastrointestinal Endoscopy, 2020Co-Authors: Sung Hyun Cho, Tae Jun Song, Do Hyun Park, Dong Wan Seo, Sung Koo Lee, Myunghwan Kim, Jong Ho Moon, Yun Nah Lee, Sang Soo LeeAbstract:Background and Aims Endoscopic ultrasound-guided Gallbladder Drainage (EUS-GBD) using an anti-migrating tubular self-expandable metal stent (ATSEMS) is performed in high surgical risk patients with acute cholecystitis. The newly introduced lumen-apposing metal stent (LAMS) is expected to reduce the risk of tubular self-expandable metal stent–related adverse events such as stent migration, but no comparative studies have been carried out between LAMSs and ATSEMSs for EUS-GBD. Methods We reviewed the prospectively collected EUS-GBD database at Asan Medical Center and Bucheon Soonchunhyang hospital to analyze consecutive patients with acute cholecystitis who underwent EUS-GBD with LAMSs or ATSEMSs between January 2015 and December 2017. Technical success, clinical success, adverse events, and recurrence of cholecystitis were evaluated. Results A total of 71 patients (36 with LAMSs, 35 with ATSEMSs) were analyzed. The LAMS group had longer median procedure time (15.5 minutes) than the ATSEMS group (11 minutes; P = .017). The 2 groups did not show significant differences in terms of technical success (LAMS, 94% vs ATSEMS, 100%; P = .49), clinical success (94% vs 100%; P = .49), procedure-related adverse events (0% vs 2.9%; P = .99), and stent-related late adverse events (11.8% vs 5.8%; P = .43). During follow-up, the 2 groups had similar rates of cholecystitis recurrence at 6 months (LAMS, 3.4% vs ATSEMS, 3.1%, P = .99) and 12 months (8.3% vs 3.1%, P = .56). Conclusions In high surgical risk patients with acute cholecystitis, LAMSs and ATSEMSs for EUS-GBD showed similar rates of technical success, clinical success, procedure-related adverse events, stent-related late adverse events, and recurrence of cholecystitis.
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long term outcomes after endoscopic ultrasonography guided Gallbladder Drainage for acute cholecystitis
Endoscopy, 2014Co-Authors: Junho Choi, Sang Soo Lee, Do Hyun Park, Dong Wan Seo, Sung Koo Lee, Joon Hyuk Choi, Myunghwan KimAbstract:Background and study aim: Endoscopic ultrasonography-guided transmural Gallbladder Drainage (EUS-GBD) has been proposed for the management of acute cholecystitis in high risk patients; however, little is known about the long-term outcomes of this treatment. The aim of this study was to evaluate the procedural and long-term outcomes of EUS-GBD with self-expandable metallic stent (SEMS). Patients and methods: Data for this retrospective study were obtained from a prospectively collected EUS database. Patients with acute cholecystitis who were deemed unsuitable for cholecystectomy were included. Study outcomes were technical and clinical success, adverse events, and stent patency. Results: EUS-GBD was technically and clinically successful in 62/63 patients (98.4 %; 95 % confidence interval [CI] 94.9 % – 100 %). Procedural adverse events included duodenal perforation (n = 1, 1.6 %) and self-limiting pneumoperitoneum (n = 2, 3.2 %), all of which resolved with conservative treatment. Long-term outcomes of EUS-GBD were evaluated in 56 patients who were followed for a median of 275 days (range 40 – 1185 days). Late adverse events developed in four patients (7.1 %; 95 %CI 5.7 % – 8.4 %), including asymptomatic distal stent migration (n = 2), and acute cholecystitis due to stent occlusion (n = 2). Two patients with occluded stent were successfully treated endoscopically (reintervention rate of 3.6 %). A total of 54 patients (96.4 %) had no recurrence of acute cholecystitis during follow-up. Median stent patency time was 190 days overall (range 15 – 1185 days) and 458 days (range 151 – 1185 days) for the 28 patients who were alive at the study end. The cumulative stent patency rate was 86 % at 3 years. Conclusions: EUS-GBD with an SEMS for acute cholecystitis showed excellent long-term outcomes and may be a definitive treatment in patients who are unsuitable for cholecystectomy because of advanced malignancy or high surgical risk.
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tg13 indications and techniques for Gallbladder Drainage in acute cholecystitis with videos
Journal of Hepato-biliary-pancreatic Sciences, 2013Co-Authors: Toshio Tsuyuguchi, Steven M. Strasberg, Henry A. Pitt, Tadahiro Takada, Toshihiko Mayumi, Masahiro Yoshida, Myunghwan Kim, Takao Itoi, A N Supe, Fumihiko MiuraAbstract:Percutaneous transhepatic Gallbladder Drainage (PTGBD) is considered a safe alternative to early cholecystectomy, especially in surgically high-risk patients with acute cholecystitis. Although randomized prospective controlled trials are lacking, data from most retrospective studies demonstrate that PTGBD is the most common Gallbladder Drainage method. There are several alternatives to PTGBD. Percutaneous transhepatic Gallbladder aspiration is a simple alternative Drainage method with fewer complications; however, its clinical usefulness has been shown only by case-series studies. Endoscopic naso-Gallbladder Drainage and Gallbladder stenting via a transpapillary endoscopic approach are also alternative methods in acute cholecystitis, but both of them have technical difficulties resulting in lower success rates than that of PTGBD. Recently, endoscopic ultrasonography-guided transmural Gallbladder Drainage has been reported as a special technique for Gallbladder Drainage. However, it is not yet an established technique. Therefore, it should be performed in high-volume institutes by skilled endoscopists. Further prospective evaluations of the feasibility, safety, and efficacy of these various approaches are needed. This article describes indications and techniques of Drainage for acute cholecystitis.
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endoscopic ultrasound guided transmural and percutaneous transhepatic Gallbladder Drainage are comparable for acute cholecystitis
Gastroenterology, 2012Co-Authors: Ji Woong Jang, Sang Soo Lee, Tae Jun Song, Yil Sik Hyun, Do Hyun Park, Dong Wan Seo, Sung Koo Lee, Myunghwan Kim, Sung Cheol YunAbstract:Background & Aims Endoscopic ultrasound-guided transmural Gallbladder Drainage (EUS-GBD) is an alternative to percutaneous transhepatic Gallbladder Drainage (PTGBD) for patients with acute, high-risk, or advanced-stage cholecystitis who do not respond to initial medical treatment and cannot undergo emergency cholecystectomy. However, the technical feasibility, efficacy, and safety of EUS-GBD and PTGBD have not been compared. Methods Fifty-nine patients with acute cholecystitis, who did not respond to initial medical treatment and were unsuitable for an emergency cholecystectomy, were chosen randomly to undergo EUS-GBD (n = 30) or PTGBD (n = 29). The technical feasibility, efficacy, and safety of EUS-GBD and PTGBD were compared. Results EUS-GBD and PTGBD showed similar technical (97% [29 of 30] vs 97% [28 of 29]; 95% 1-sided confidence interval lower limit, −7%; P = .001 for noninferiority margin of 15%) and clinical (100% [29 of 29] vs 96% [27 of 28]; 95% 1-sided confidence interval lower limit, −2%; P = .0001 for noninferiority margin of 15%) success rates, and similar rates of complications (7% [2 of 30] vs 3% [1 of 29]; P = .492 in the Fisher exact test) and conversions to open cholecystectomy (9% [2 of 23] vs 12% [3 of 26]; P = .999 in the Fisher exact test). The median post-procedure pain score was significantly lower after EUS-GBD than after PTGBD (1 vs 5; P U test). Conclusions EUS-GBD is comparable with PTGBD in terms of the technical feasibility and efficacy; there were no statistical differences in the safety. EUS-GBD is a good alternative for high-risk patients with acute cholecystitis who cannot undergo an emergency cholecystectomy.
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endoscopic ultrasound guided transmural and percutaneous transhepatic Gallbladder Drainage are comparable for acute cholecystitis
Gastroenterology, 2012Co-Authors: Ji Woong Jang, Sang Soo Lee, Tae Jun Song, Yil Sik Hyun, Do Hyun Park, Dong Wan Seo, Sung Koo Lee, Myunghwan Kim, Sung Cheol YunAbstract:Background & Aims Endoscopic ultrasound-guided transmural Gallbladder Drainage (EUS-GBD) is an alternative to percutaneous transhepatic Gallbladder Drainage (PTGBD) for patients with acute, high-risk, or advanced-stage cholecystitis who do not respond to initial medical treatment and cannot undergo emergency cholecystectomy. However, the technical feasibility, efficacy, and safety of EUS-GBD and PTGBD have not been compared. Methods Fifty-nine patients with acute cholecystitis, who did not respond to initial medical treatment and were unsuitable for an emergency cholecystectomy, were chosen randomly to undergo EUS-GBD (n = 30) or PTGBD (n = 29). The technical feasibility, efficacy, and safety of EUS-GBD and PTGBD were compared. Results EUS-GBD and PTGBD showed similar technical (97% [29 of 30] vs 97% [28 of 29]; 95% 1-sided confidence interval lower limit, −7%; P = .001 for noninferiority margin of 15%) and clinical (100% [29 of 29] vs 96% [27 of 28]; 95% 1-sided confidence interval lower limit, −2%; P = .0001 for noninferiority margin of 15%) success rates, and similar rates of complications (7% [2 of 30] vs 3% [1 of 29]; P = .492 in the Fisher exact test) and conversions to open cholecystectomy (9% [2 of 23] vs 12% [3 of 26]; P = .999 in the Fisher exact test). The median post-procedure pain score was significantly lower after EUS-GBD than after PTGBD (1 vs 5; P Conclusions EUS-GBD is comparable with PTGBD in terms of the technical feasibility and efficacy; there were no statistical differences in the safety. EUS-GBD is a good alternative for high-risk patients with acute cholecystitis who cannot undergo an emergency cholecystectomy.
Anthony Yuen Bun Teoh - One of the best experts on this subject based on the ideXlab platform.
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eus guided Gallbladder Drainage versus laparoscopic cholecystectomy for acute cholecystitis a propensity score analysis with 1 year follow up data
Gastrointestinal Endoscopy, 2021Co-Authors: Anthony Yuen Bun Teoh, Hon Chi Yip, Shannon M Chan, Chi Ho Leung, Prudence Taihuen Tam, Kitty Kit Ying Au Yeung, Richard Chung Ying Mok, Daniel L Chan, Philip Wai Yan ChiuAbstract:Background and Aims EUS-guided Gallbladder Drainage (EUS-GBD) is a safe alternative to percutaneous cholecystostomy (PT-GBD) for acute cholecystitis. How the procedure compares with laparoscopic cholecystectomy (LC) is uncertain. The aim of the current study is to compare the outcomes of EUS-GBD with LC for acute cholecystitis. Methods This was propensity score analysis of all patients admitted for acute cholecystitis between 2012 and 2018. Consecutive patients who received EUS-GBD or LC were included. Patients were matched for age, sex, and age-adjusted Charlson score. Outcome measurements included 30-day adverse events, mortality, recurrent cholecystitis, recurrent biliary events, reinterventions, and readmissions. Results During the study period, 60 patients were selected (30 EUS-GBD vs 30 LC) after propensity score matching. Technical success rates (100% vs 100%), clinical success rates (93.3% vs 100%, P = 1), lengths of hospital stay (6.8 [8.1] vs 5.5 [2.7], P = 1), 30-day adverse events (4 [13.3%] vs 4 [13.3%], P = 1), and mortality rates (2 [6.7%] vs 0 [0%], P = .492) were similar. The rates of recurrent biliary events (3 [10%] vs 3 [10%], P = .784), reinterventions (4 [13.3%] vs 3 [10%], P = 1), and unplanned readmissions (3 [10%] vs 3 [10%], P = .784) in 1 year were also similar. Conclusions The outcomes of EUS-GBD for acute cholecystitis were comparable with LC with acceptable rates of recurrent acute cholecystitis. These results support the role of EUS-GBD as an alternative to LC in patients who may or may not be surgically fit to undergo definitive cholecystectomy.
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comparison of eus guided endoscopic transpapillary and percutaneous Gallbladder Drainage for acute cholecystitis a systematic review with network meta analysis
Gastrointestinal Endoscopy, 2020Co-Authors: Alexander Podboy, Shannon M Chan, Jacky Yuan, Christopher D Stave, Joo Ha Hwang, Anthony Yuen Bun TeohAbstract:Background and Aims The optimal method of Gallbladder Drainage (GBD) for acute cholecystitis in nonsurgical candidates is uncertain. The aim of the current study was to conduct a network meta-analysis comparing the 3 methods of GBD (percutaneous [PT], endoscopic transpapillary [ETP], and EUS-guided). Methods A comprehensive literature search for all comparative studies assessing the efficacy of either 2 or all modalities used for treatment of acute cholecystitis in patients at high risk for cholecystectomy was performed. Primary outcomes of technical and clinical success and postprocedure adverse events were assessed. Secondary outcomes were reintervention, unplanned readmissions, recurrent cholecystitis, and mortality. Results Ten studies were identified, comprising 1267 patients (472 EUS-GBD, 493 PT-GBD, and 302 ETP-GBD). In the network ranking estimate, PT-GBD and EUS-GBD had the highest likelihood of technical success (EUS-GBD vs PT-GBD vs ETP-GBD: 2.00 vs 1.02 vs 2.98) and clinical success (EUS-GBD vs PT-GBD vs ETP-GBD: 1.48 vs 1.55 vs 2.98). EUS-GBD had the lowest risk of recurrent cholecystitis (EUS-GBD vs PT-GBD vs ETP-GBD: 1.089 vs 2.02 vs 2.891). PT-GBD had the highest risk of reintervention (EUS-GBD vs PT-GBD vs ETP-GBD: 1.81 vs 2.99 vs 1.199) and unplanned readmissions (EUS-GBD vs PT-GBD vs ETP-GBD: 1.582 vs 2.944 vs 1.474), whereas ETP-GBD was associated with the lowest rates of mortality (EUS-GBD vs PT-GBD vs ETP-GBD: 2.62 vs 2.09 vs 1.29). Conclusions The 3 modalities of GBD have their respective advantages and disadvantages. Selection of technique will depend on available expertise. In centers with expertise in endoscopic GBD, the techniques are preferred over PT-GBD with improved outcomes. (Clinical trial registration number: CRD42020181972.)
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endosonography guided Gallbladder Drainage versus percutaneous cholecystostomy in very high risk surgical patients with acute cholecystitis an international randomised multicentre controlled superiority trial drac 1
Gut, 2020Co-Authors: Anthony Yuen Bun Teoh, Manuel Perezmiranda, Takao Itoi, Carlos De La Sernahiguera, Takeshi Ogura, Masayuki Kitano, Shunsuke Omoto, Shannon M Chan, Raul Torresyuste, Takayoshi TsuichiyaAbstract:Objective The optimal management of acute cholecystitis in patients at very high risk for cholecystectomy is uncertain. The aim of the current study was to compare endoscopic ultrasound (EUS)-guided Gallbladder Drainage (EUS-GBD) to percutaneous cholecystostomy (PT-GBD) as a definitive treatment in these patients under a randomised controlled trial. Design Consecutive patients suffering from acute calculous cholecystitis but were at very high-risk for cholecystectomy were recruited. The primary outcome was the 1-year adverse events rate. Secondary outcomes include technical and clinical success, 30-day adverse events, pain scores, unplanned readmissions, re-interventions and mortalities. Results Between August 2014 to February 2018, 80 patients were recruited. EUS-GBD significantly reduced 1 year adverse events (10 (25.6%) vs 31 (77.5%), p Conclusion EUS-GBD improved outcomes as compared to PT-GBD in those patients that not candidates for cholecystectomy. EUS-GBD should be the procedure of choice provided that the expertise is available after a multi-disciplinary meeting. Further studies are required to determine the long-term efficacy. Trial registration number NCT02212717
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outcomes of an international multicenter registry on eus guided Gallbladder Drainage in patients at high risk for cholecystectomy
Endoscopy International Open, 2019Co-Authors: Anthony Yuen Bun Teoh, Manuel Perezmiranda, Todd H Baron, Rastislav Kunda, Sang Soo Lee, Shayan Irani, Paul Yeaton, Siyu Sun, Jong Ho Moon, Bronte A HoltAbstract:Background and study aims The aim of the current study was to review the outcomes of a large-scale international registry on endoscopic ultrasound-guided Gallbladder Drainage (EGBD) that encompasses different stent systems in patients who are at high-risk for cholecystectomy. Patients and methods This was a retrospective international multicenter registry on EGBD created by 13 institutions around the world. Consecutive patients who received EGBD for several indications were included. Outcomes include technical and clinical success, unplanned procedural events (UPE), adverse events (AEs), mortality, recurrent cholecystitis and learning curve of the procedure. Results Between June 2011 and November 2017, 379 patients were recruited to the study. Technical and clinical success were achieved in 95.3 % and 90.8 % of the patients, respectively. The 30-day AE rate was 15.3 % and 30-day mortality was 9.2 %. UPEs were significantly more common in patients with EGBD performed for conversion of cholecystostomy and symptomatic gallstones (P Conclusion EGBD was associated with high success rates in this large-scale study. EGBD performed for indications other than acute cholecystitis was associated with higher UPEs. The number of cases required to gain competency with the technique by experienced interventional endosonographers was 25 procedures.
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Current Status of Endoscopic Gallbladder Drainage
Hoon Jai Chun, 2018Co-Authors: Joey Ho Yi Chan, Anthony Yuen Bun TeohAbstract:The gold standard for treatment of acute cholecystitis is laparoscopic cholecystectomy. However, cholecystectomy is often not suitable for surgically unfit patients who are too frail due to various co-morbidities. As such, several less invasive endoscopic treatment modalities have been developed to control sepsis, either as a definitive treatment or as a temporizing modality until the patient is stable enough to undergo cholecystectomy at a later stage. Recent developments in endoscopic ultrasound-guided Gallbladder Drainage (EUS-GBD) with endoscopic ultrasound EUS-specific stents having lumen-apposing properties have demonstrated potential as a definitive treatment modality. Furthermore, advanced Gallbladder procedures can be performed using the stents as a portal. With similar effectiveness as percutaneous transhepatic cholecystostomy and lower rates of adverse events reported in some studies, EUS-GBD has opened exciting possibilities in becoming the next best alternative in treating acute cholecystitis in surgically unfit patients. The aim of this review article is to provide a summary of the various methods of Gallbladder Drainage GBD with particular focus on EUS-GBD and the many new prospects it allows
Takao Itoi - One of the best experts on this subject based on the ideXlab platform.
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endosonography guided Gallbladder Drainage versus percutaneous cholecystostomy in very high risk surgical patients with acute cholecystitis an international randomised multicentre controlled superiority trial drac 1
Gut, 2020Co-Authors: Anthony Yuen Bun Teoh, Manuel Perezmiranda, Takao Itoi, Carlos De La Sernahiguera, Takeshi Ogura, Masayuki Kitano, Shunsuke Omoto, Shannon M Chan, Raul Torresyuste, Takayoshi TsuichiyaAbstract:Objective The optimal management of acute cholecystitis in patients at very high risk for cholecystectomy is uncertain. The aim of the current study was to compare endoscopic ultrasound (EUS)-guided Gallbladder Drainage (EUS-GBD) to percutaneous cholecystostomy (PT-GBD) as a definitive treatment in these patients under a randomised controlled trial. Design Consecutive patients suffering from acute calculous cholecystitis but were at very high-risk for cholecystectomy were recruited. The primary outcome was the 1-year adverse events rate. Secondary outcomes include technical and clinical success, 30-day adverse events, pain scores, unplanned readmissions, re-interventions and mortalities. Results Between August 2014 to February 2018, 80 patients were recruited. EUS-GBD significantly reduced 1 year adverse events (10 (25.6%) vs 31 (77.5%), p Conclusion EUS-GBD improved outcomes as compared to PT-GBD in those patients that not candidates for cholecystectomy. EUS-GBD should be the procedure of choice provided that the expertise is available after a multi-disciplinary meeting. Further studies are required to determine the long-term efficacy. Trial registration number NCT02212717
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tokyo guidelines 2018 management strategies for Gallbladder Drainage in patients with acute cholecystitis with videos
Journal of Hepato-biliary-pancreatic Sciences, 2018Co-Authors: Yasuhisa Mori, Steven M. Strasberg, Henry A. Pitt, Todd H Baron, Tadahiro Takada, Takao Itoi, Tomohiko Ukai, Satoru Shikata, Yoshinori Noguchi, Anthony Y TeohAbstract:Since the publication of the Tokyo Guidelines in 2007 and their revision in 2013, appropriate management for acute cholecystitis has been more clearly established. Since the last revision, several manuscripts, especially for alternative endoscopic techniques, have been reported; therefore, additional evaluation and refinement of the 2013 Guidelines is required. We describe a standard Drainage method for surgically high-risk patients with acute cholecystitis and the latest developed endoscopic Gallbladder Drainage techniques described in the updated Tokyo Guidelines 2018 (TG18). Our study confirmed that percutaneous transhepatic Gallbladder Drainage should be considered the first alternative to surgical intervention in surgically high-risk patients with acute cholecystitis. Also, endoscopic transpapillary Gallbladder Drainage or endoscopic ultrasound-guided Gallbladder Drainage can be considered in high-volume institutes by skilled endoscopists. In the endoscopic transpapillary approach, either endoscopic naso-Gallbladder Drainage or Gallbladder stenting can be considered for Gallbladder Drainage. We also introduce special techniques and the latest outcomes of endoscopic ultrasound-guided Gallbladder Drainage studies. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.
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percutaneous and endoscopic Gallbladder Drainage for acute cholecystitis international multicenter comparative study using propensity score matched analysis
Journal of Hepato-biliary-pancreatic Sciences, 2017Co-Authors: Takao Itoi, Fumihiko Miura, Tadahiro Takada, Tsannlong Hwang, Itaru Endo, Kohei Akazawa, Miinfu Chen, Yiyin Jan, Chenguo Ker, Hsiupo WangAbstract:Background Tokyo Guideline 2013 (TG13) proposed three Drainage techniques for the treatment of acute cholecystitis. We evaluated the clinical efficacy and adverse events between percutaneous transhepatic intervention (PTGBI) including percutaneous transhepatic Gallbladder Drainage (PTGBD) and percutaneous transhepatic Gallbladder aspiration (PTGBA) and endoscopic transpapillary Gallbladder Drainage (EGBD). Methods A cohort study was performed using propensity score matching to reduce treatment selection bias. This involved the analysis of collected data for 1,764 patients who underwent PTGBI and EGBD. Results Propensity score matching extracted 330 pairs of patients. The difference in the clinical success rate within 3 days between PTGBI and EGBD were 62.5% and 69.8%, respectively (P = 0.085). The differences in the suboptimal clinical success rates within 7 days between PTGBI and EGBD were 87.6% and 89.2% (P = 0.579). The differences in the complication rate between PTGBI and EGBD were 4.8% and 8.2% (P = 0.083). The differences in the complication rate among PTGBD, PTGBA and EGBD were 5.6%, 1.6% and 8.2% (P = 0.11). Median required days of PTGBD (3.0 days) was significantly longer than those of PTGBA and EGBD (1.5 and 2.0 days, respectively) (P = 0.001). Conclusion The current study showed the PTGBI showed similar clinical efficacy compared with EGBD without significant discrepancy of complication rate for the treatment of acute cholecystitis.
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optimal treatment strategy for acute cholecystitis based on predictive factors japan taiwan multicenter cohort study
Journal of Hepato-biliary-pancreatic Sciences, 2017Co-Authors: Itaru Endo, Fumihiko Miura, Tadahiro Takada, Takao Itoi, Tsannlong Hwang, Kohei Akazawa, Rintaro Mori, Masamichi Yokoe, Harumi Gomi, Miinfu ChenAbstract:Background Although early laparoscopic cholecystectomy is widely performed for acute cholecystitis, the optimal timing of a cholecystectomy in clinically ill patients remains controversial. This study aims to determine the best practice for the patients presenting with acute cholecystitis focused on disease severity and comorbidities. Methods An international multicentric retrospective observational study was conducted over a 2-year period. Patients were divided into four groups: Group A: primary cholecystectomy; Group B: cholecystectomy after Gallbladder Drainage; Group C: Gallbladder Drainage alone; and Group D: medical treatment alone. Results The subjects of analyses were 5,329 patients. There were statistically significant differences in mortality rates between patients with Charlson comorbidity index (CCI) scores below and above 6 (P < 0.001). The shortest operative time was observed in Group A patients who underwent surgery 0–3 days after admission (P < 0.01). Multiple regression analysis revealed CCI and low body mass index <20 as predictive factors of 30-day mortality in Grade I+II patients. Also, jaundice, neurological dysfunction, and respiratory dysfunction were predictive factors of 30-day mortality in Grade III patients. In Grade III patients without predictive factors, there were no difference in mortality between Group A and Group B (0% vs. 0%), whereas Group A patients had higher mortality rates than that of Group B patients (9.3% vs. 0.0%) in cases with at least one predictive factor. Conclusion Even patients with Grade III severity, primary cholecystectomy can be performed safely if they have no predictive factors of mortality. Gallbladder Drainage may have a therapeutic role in subgroups with higher CCI or higher disease severity.
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endoscopic ultrasonography guided biliary and pancreatic duct interventions
Digestive Endoscopy, 2017Co-Authors: Vinay Dhir, Hiroyuki Isayama, Takao Itoi, Majid A Almadi, Aroon Siripun, Anthony Yuen Bun TeohAbstract:Drainage of obstructed bile duct and pancreatic duct under endoscopic ultrasonography (EUS) guidance has evolved into viable techniques suitable for patients with failed endoscopic retrograde cholangiopancreatography (ERCP) and/or altered surgical anatomy. One of the major advantages of EUS guidance is the possibility of multiple access points depending upon patient and ductal anatomy. Unlike ERCP, an approachable papilla is not a requisite for successful EUS-guided biliary or pancreatic ductal Drainage. Moreover, as the access is away from the papilla, there is the possibility of reduced pancreatitis. A variety of procedures have become available for EUS-guided Drainage, and it is important to develop standard terminology and procedural details. EUS-specific stents, including lumen-apposing metal stents have recently become available, and are likely to impact the outcomes of these procedures. Available data show a high success rate and acceptable adverse event rate for EUS-guided biliary Drainage. Success rate appears to be low for pancreatic duct Drainage because of a variety of reasons. Outcomes of EUS-guided biliary Drainage appear equivalent to percutaneous Drainage and ERCP. EUS-guided Gallbladder Drainage appears promising for patients requiring Gallbladder Drainage but unfit for surgery. Further large controlled studies are needed to evaluate the exact role of these procedures.
