Endoscopic Ultrasound-Guided Gallbladder Drainage Using a Lumen-Apposing Metal Stent for Acute Cholecystitis: A Systematic Review.
- Author:
Deepanshu JAIN
1
;
Bharat Singh BHANDARI
;
Nikhil AGRAWAL
;
Shashideep SINGHAL
Author Information
- Publication Type:Review
- Keywords: Acute cholecystitis; Endoscopic ultrasound; Lumen-apposing metal stent
- MeSH: Anti-Bacterial Agents; Ascites; Cautery; Cholecystitis; Cholecystitis, Acute*; Cystic Duct; Drainage*; Gallbladder*; Hemorrhage; Hospitalization; Humans; Pain, Postoperative; Stents*
- From:Clinical Endoscopy 2018;51(5):450-462
- CountryRepublic of Korea
- Language:English
- Abstract: Surgery remains the standard treatment for acute cholecystitis except in high-risk candidates where percutaneous transhepatic gallbladder drainage (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 patients owing to aesthetic reasons. ET-CDS is successful only if the cystic duct can be visualized and cannulated. For 189 patients who underwent EUS-GBD via insertion of a lumen-apposing metal stent (LAMS), the composite technical success rate was 95.2%, which increased to 96.8% when LAMS was combined with co-axial self-expandable metal stent (SEMS). The composite clinical success rate was 96.7%. We observed a small risk of recurrent cholecystitis (5.1%), gastrointestinal bleeding (2.6%) and stent migration (1.1%). Cautery enhanced LAMS significantly decreases the stent deployment time compared to non-cautery enhanced LAMS. Prophylactic placement of 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 efficacy of EUS-GBD via LAMS is comparable to that of PT-GBD with the former showing better results in postoperative pain, length of hospitalization, and need for antibiotics. EUS-GBD via LAMS is a safe and efficacious option when performed by experts.
