Endoscopic ultrasound-guided gallbladder drainage for acute cholecystitis with a silicone-covered nitinol short bilaterally flared stent: a case series

Abstract

Background and study aim Gallbladder drainage in patients with cholecystitis who are unsuitable for surgery may be performed by endoscopic ultrasound (EUS)-guided placement of specifically designed fully covered metal stents. We describe the first case series of patients treated with a silicone-covered nitinol stent with bilateral anchor flanges.

Patients and methods Data from consecutive patients with acute cholecystitis who were deemed unsuitable candidates for surgery were collected. The stent placement procedure was performed in two tertiary endoscopy centers by four experienced endoscopists. Technical and clinical success rates, as well as adverse events and clinical outcome at follow-up, were assessed.

Results EUS-guided drainage for cholecystitis was performed in 16 patients (mean age 84 years; nine males). Technical and clinical success rates were 100 % (16/16) and 94 % (15/16), respectively; an early failure due to stone impaction occurred in the remaining case and required placement of a new stent. Symptom relief occurred in 11/15 cases (73 %) within 1 day, and within 2 days in the remaining 4 patients. Bleeding occurred in two patients (13 %): in one patient intraprocedural bleeding was successfully stopped during endoscopy; and delayed bleeding occurred in one patient requiring arterial embolization for catastrophic bleeding (patient died 10 days later). No cases of cholecystitis recurrence or biliary obstruction were observed during a median follow-up of 112 days (range 49 – 180 days).

Conclusions Our data showed that EUS-guided gallbladder drainage with a specially designed stent is feasible and successful in patients with acute cholecystitis who are unfit for surgery.

• References

• 1 Coccolini F, Catena F, Pisano M. et al. Open versus laparoscopic cholecystectomy in acute cholecystitis. Systematic review and meta-analyis. Int J Surg 2015; 18: 196-204
• 2 Baron TH, Grimm IS. Nonsurgical management of cholecystitis: a tailored approach. Gastrointest Endosc 2015; 82: 1037-1038
• 3 Hatzidakis AA, Prassopoulos P, Petinarakis I. et al. Acute cholecystitis in high-risk patients: percutaneous cholecystostomy vs conservative treatment. Eur Radiol 2002; 12: 1778-1784
• 4 Jang WS, Lim JU, Joo KR. et al. Outcome of conservative percutaneous cholecystostomy in high-risk patients with acute cholecystitis and risk factors leading to surgery. Surg Endosc 2015; 29: 2359-2364
• 5 Mutignani M, Iacopini F, Perri V. et al. Endoscopic gallbladder drainage for acute cholecystitis: technical and clinical results. Endoscopy 2009; 41: 539-546
• 6 Khasbab MA, Levy MJ, Itoi T. et al. EUS-guided biliary drainage. Gastrointest Endosc 2015; 82: 993
• 7 Peñas-Herrero I, de la Serna-Higuera C, Perez-Miranda M. Endoscopic ultrasound-guided gallbladder drainage for the management of acute cholecystitis (with video). J Hepatobiliary Pancreat Sci 2015; 22: 35-43
• 8 Itoi T, Coelho-Prabhu N, Baron TH. Endoscopic gallbladder drainage for management of acute cholecystitis. Gastrointest Endosc 2010; 71: 1038-1045
• 9 Pannala R, Petersen BT, Gostout CJ. et al. Endoscopic transpapillary gallbladder drainage: 10-year single center experience. Minerva Gastroenterol Dietol 2008; 54: 107-113
• 10 Bakkaloglu H, Yanar H, Guloglu R. et al. Ultrasound guided percutaneous cholecystostomy in high-risk patients for surgical intervention. World J Gastroenterol 2006; 12: 7179-7182
• 11 Spira RM, Nissan A, Zamir O. et al. Percutaneous transhepatic cholecystostomy and delayed laparoscopic cholecystectomy in critically ill patients with acute calculus cholecystitis. Am J Surg 2002; 183: 62-66
• 12 Choi J-H, Lee SS, Choi JH. et al. Long-term outcomes after endoscopic ultrasonography-guided gallbladder drainage for acute cholecystitis. Endoscopy 2014; 46: 656-661
• 13 Itoi T, Binmoeller KF, Shah J. et al. Clinical evaluation of a novel lumen-apposing metal stent for endosonography-guided pancreatic pseudocyst and gallbladder drainage (with videos). Gastrointest Endosc 2012; 75: 870-876
• 14 Anderloni A, Buda A, Vieceli F. et al. Endoscopic ultrasound-guided transmural stenting for gallbladder drainage in high-risk patients with acute cholecystitis: a systematic review and pooled analysis. Surg Endosc 2016; 30: 5200-5208
• 15 Patil R, Papafragkakis C, Anand S. et al. Endoscopic ultrasound-guided placement of the lumen-apposing self-expandable metallic stent for gallbladder drainage: a promising technique. Ann Gastroenterol 2016; 29: 162-167
• 16 Weilert F, Binmoeller KF. et al. Specially designed stents for translumenal drainage. Gastrointest Interv 2015; 4: 40-45
• 17 Itoi T, Nagashwar Reddy D, Yashuda I. New fully-covered self-expandable metal stent for endoscopic ultrasonography-guided intervention in infectious walled-of pancreatic necrosis (with video). J Hepatobiliary Pancreat Sci 2013; 20: 403-406
• 18 Tellez-Avila FI, Villabos-Garita A, Ramirez-Luna MA. Use of a self-expandable metal stent with an anti-migration system for endoscopic ultrasound-guided drainage of a pseudocyct. World J Gastrointest Endosco 2013; 5: 297-299
• 19 Keane MG, Sze SF, Cieplik N. et al. Endoscopic versus percutaneous drainage of symptomatic pancreatic fluid collections: a 14-year experience from a tertiary hepatobiliary centre. Surg Endosc 2016; 30; 3730-3740
• 20 Rai P, Singh A, Rao R. et al. First report of endoscopic ultrasound-guided cholecystogastrostomy with a Nagi covered metal stent for palliation of jaundice in extrahepatic biliary obstruction. Endoscopy 2014; 46: e334-e335
• 21 Takada T, Strasberg SM, Solomkin JS. et al. Tokyo Guidelines Revision Committee. TG13: Updated Tokyo Guidelines for the management of acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci 2013; 20: 1-7
• 22 Widemar J, Singhal S, Gaidhane M. et al. Endoscopic ultrasound-guided endoluminal drainage of the gallbladder. Dig Endosc 2014; 26: 525-531
• 23 Choi JH, Lee SS. Endoscopic ultrasound-guided endoluminal drainage for acute cholecystitis. Dig Endosc 2014; 27: 1-7
• 24 Irani S, Ngamruengphong S, Teoh A. et al. Similar efficacies of endoscopic ultrasound gallbladder drainage with a lumen-apposing metal stent versus percutaneous transhepatic gallbladder drainage for acute cholecystitis. Clin Gastroenterol Hepatol 2017; 15: 738-745
• 25 Teoh AYB, Serna C, Penas I. et al. Endoscopic ultrasound-guided gallbladder drainage reduces adverse events compared with percutaneous cholecystostomy in patients who are unfit for cholecystectomy. Endoscopy 2017; 49: 130-138
• 26 Tyberg A, Saumoy M, Sequeiros EV. et al. EUS-guided versus percutaneous gallbladder drainage: isn’t it time to convert?. J Clin Gastroenterol 2016;
• 27 Kwan V, Eisendrath P, Antaki F. et al. EUS-guided cholecystenterostomy: a new technique (with videos). Gastrointest Endosc 2007; 66: 582-586
• 28 Teoh AY, Ng EK, Chan SM. et al. Ex vivo comparison of the lumen-apposing properties of EUS-specific stents (with video). Gastrointest Endosc 2016; 84: 62-68