EUS-guided gallbladder drainage with a lumen-apposing metal stent (with video)

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• 作者：Shayan Irani ; MD<sup>1sup><sup> ; sup> ; Todd H. Baron ; MD<sup>2sup> ; Ian S. Grimm ; MD<sup>2sup> ; Mouen A. Khashab ; MD<sup>3sup>
• 关键词：EUS-GBD ; EUS-guided gallbladder drainage ; LAMS ; lumen-apposing metal stent ; PT-GBD ; percutaneous transhepatic gallbladder drainage
• 刊名：Gastrointestinal Endoscopy
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：82
• 期：6
• 页码：1110-1115
• 全文大小：1278 K

文摘

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).

sSec_2">Patients and Methods

spara0015">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.

sSec_3">Results

spara0020">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.

sSec_4">Conclusions

spara0025">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.