BACKGROUND/AIMS: Surgery is the mainstay of treatment for cholecystitis. However, gallbladder stenting (GBS) has shown promise in debilitated or high-risk patients. Endoscopic transpapillary GBS and endoscopic ultrasound-guided GBS (EUS-GBS) have been proposed as safe and effective modalities for gallbladder drainage. METHODS: Data from patients with cholecystitis were prospectively collected from August 2004 to May 2013 from two United States academic university hospitals and analyzed retrospectively. The following treatment algorithm was adopted. Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and cystic duct stenting was initially attempted. If deemed feasible by the endoscopist, EUS-GBS was then pursued. RESULTS: During the study period, 139 patients underwent endoscopic gallbladder drainage. Among these, drainage was performed in 94 and 45 cases for benign and malignant indications, respectively. Successful endoscopic gallbladder drainage was defined as decompression of the gallbladder without incidence of cholecystitis, and was achieved with ERCP and cystic duct stenting in 117 of 128 cases (91%). Successful endoscopic gallbladder drainage was also achieved with EUS-guided gallbladder drainage using transmural stent placement in 11 of 11 cases (100%). Complications occurred in 11 cases (8%). CONCLUSIONS: Endoscopic gallbladder drainage techniques are safe and efficacious methods for gallbladder decompression in non-surgical patients with comorbidities.
Cholangiopancreatography, Endoscopic Retrograde ; Cholecystitis ; Cholecystitis, Acute* ; Comorbidity ; Cystic Duct ; Decompression ; Drainage* ; Gallbladder* ; Hospitals, University ; Humans ; Incidence ; Prospective Studies ; Retrospective Studies ; Stents ; United States

BACKGROUND

Cardiovascular disease (CVD) is a group of disorders of the heart and blood vessels, which includes coronary heart disease, cerebrovascular disease, and peripheral artery disease. It is currently the leading cause of death worldwide. Currently, there is paucity in the available epidemiologic data of CVD in Southeast Asia (SEA).

OBJECTIVE

To determine the prevalence, mortality rate, and associated risk factors of CVD (specifically ischemic heart disease, stroke, and peripheral artery disease) among adult populations in SEA.

METHODS

A systematic review of published articles between 2015 and 2020 was conducted. The authors also searched the World Health Organization database and publicly available health department websites of Southeast Asian countries.

RESULTS

The overall prevalence of CVDs in SEA is 5.48%. Specifically, the prevalence of ischemic heart disease is 1.54% and is highest in Thailand (2.54%). Ischemic stroke has a prevalence of 1.03% and is highest in Indonesia (1.97%). Prevalence of peripheral artery disease is 1.36% and is also highest in Thailand (1.92%). Mortality rate from CVD in SEA is 13.41%. Hypercholesterolemia, smoking, and hypertension are the most common risk factors, with prevalence of 41.2%, 21.1%, and 20.9%, respectively.

CONCLUSION

The prevalence and mortality rate of CVD in SEA remain high and are associated with high prevalence of underlying risk factors. Interventions should be strengthened to improve the overall picture in the region. Collaborative efforts among Southeast Asian countries are essential not only in generating comparative epidemiologic data but also in sharing best practices in lowering CVD mortality and morbidity.

Cardiovascular Diseases ; Myocardial Ischemia ; ischemic heart disease ; Stroke ; Peripheral Arterial Disease ; Risk Factors ; Asia, Southeastern