Clin Endosc.  2018 Sep;51(5):450-462. 10.5946/ce.2018.024.

Endoscopic Ultrasound-Guided Gallbladder Drainage Using a Lumen-Apposing Metal Stent for Acute Cholecystitis: A Systematic Review

• Jain D
• Bhandari B
• Agrawal N
• Singhal S

• KMID: 2427718
• DOI: http://doi.org/10.5946/ce.2018.024

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.

Keyword

Acute cholecystitis; Endoscopic ultrasound; Lumen-apposing metal stent

MeSH Terms

Anti-Bacterial Agents
Ascites
Cautery
Cholecystitis
Cholecystitis, Acute*
Cystic Duct
Drainage*
Gallbladder*
Hemorrhage
Hospitalization
Humans
Pain, Postoperative
Stents*
Anti-Bacterial Agents

Reference

1. Hassler KR, Jones MW. Gallbladder, cholecystectomy, laparoscopic [Internet]. Treasure Island (FL): StatPearls Publishing;c2017. [updated 2017 Oct 16; cited 2018 Apr 12]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448145/.

2. Friedman GD, Raviola CA, Fireman B. Prognosis of gallstones with mild or no symptoms: 25 years of follow-up in a health maintenance organization. J Clin Epidemiol. 1989; 42:127–136.

3. Garden OJ, Bradbury AW, Forsythe JLR. Principles and practice of surgery. 4th ed. Edinburgh: Churchill Livingstone;2002.

4. Zacks SL, Sandler RS, Rutledge R, Brown RS Jr. A population-based cohort study comparing laparoscopic cholecystectomy and open cholecystectomy. Am J Gastroenterol. 2002; 97:334–340.

5. Itoi T, Sofuni A, Itokawa F, et al. Endoscopic transpapillary gallbladder drainage in patients with acute cholecystitis in whom percutaneous transhepatic approach is contraindicated or anatomically impossible (with video). Gastrointest Endosc. 2008; 68:455–460.

6. Widmer J, Alvarez P, Sharaiha RZ, et al. Endoscopic gallbladder drainage for acute cholecystitis. Clin Endosc. 2015; 48:411–420.

7. de la Serna-Higuera C, Pérez-Miranda M, Gil-Simón P, et al. EUS-guided transenteric gallbladder drainage with a new fistula-forming, lumen-apposing metal stent. Gastrointest Endosc. 2013; 77:303–308.

8. Itoi T, Binmoeller K, Itokawa F, Umeda J, Tanaka R. Endoscopic ultrasonography-guided cholecystogastrostomy using a lumen-apposing metal stent as an alternative to extrahepatic bile duct drainage in pancreatic cancer with duodenal invasion. Dig Endosc. 2013; 25 Suppl 2:137–141.

9. Itoi T, Itokawa F, Tsuchiya T, Kurihara T, Tanaka R. Transgastric large gallstone extraction through a lumen-apposing metal stent in a patient with acute cholecystitis. Gastrointest Endosc. 2014; 79:547.

10. Tharian B, Varadarajulu S, Hawes R. Drainage of obstructed gallbladder with use of lumen-apposing metal stent. Gastrointest Endosc. 2016; 83:460–461.

11. Irani S, Baron TH, Grimm IS, Khashab MA. EUS-guided gallbladder drainage with a lumen-apposing metal stent (with video). Gastrointest Endosc. 2015; 82:1110–1115.

12. Kumta NA, Lordello Passos M, Rodela Silva GL, Novikov A, Kahaleh M. Endoscopic ultrasound-guided transmural gallbladder drainage with a lumen-apposing metal stent using an electrocautery enhanced delivery system. Endoscopy. 2016; 48:E327.

13. Law R, Grimm IS, Stavas JM, Baron TH. Conversion of percutaneous cholecystostomy to internal transmural gallbladder drainage using an endoscopic ultrasound-guided, lumen-apposing metal stent. Clin Gastroenterol Hepatol. 2016; 14:476–480.

14. Dollhopf M, Larghi A, Will U, et al. EUS-guided gallbladder drainage in patients with acute cholecystitis and high surgical risk using an electrocautery-enhanced lumen-apposing metal stent device. Gastrointest Endosc. 2017; 86:636–643.

15. 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.

16. Walter D, Teoh AY, Itoi T, et al. EUS-guided gall bladder drainage with a lumen-apposing metal stent: a prospective long-term evaluation. Gut. 2016; 65:6–8.

17. Binmoeller KF, Shah J. A novel lumen-apposing stent for transluminal drainage of nonadherent extraintestinal fluid collections. Endoscopy. 2011; 43:337–342.