Medline ® Abstracts for References 9-11
EUS-guided transmural cholecystostomy as rescue management for acute cholecystitis in elderly or high-risk patients: a prospective feasibility study.
Lee SS, Park DH, Hwang CY, Ahn CS, Lee TY, Seo DW, Lee SK, Kim MW
Gastrointest Endosc. 2007;66(5):1008.
BACKGROUND: Although EUS-guided drainage procedures have been used to collect peripancreatic fluids, little is known regarding EUS-guided transmural gallbladder drainage for high-risk patients with acute cholecystitis.
OBJECTIVE: Our purpose was to evaluate the technical feasibility and outcomes of EUS-guided transmural cholecystostomy as rescue management in elderly and high-risk patients with acute cholecystitis.
DESIGN: Single-center prospective study.
SETTING: Tertiary referral center.
PATIENTS: Nine elderly or high-risk patients diagnosed with acute cholecystitis.
INTERVENTIONS: All inflamed gallbladders were drained by EUS-guided transmural cholecystostomy.
MAIN OUTCOME MEASUREMENT: Clinical resolution of acute cholecystitis.
RESULTS: After the drainage procedures, there were no immediate complications such as bleeding, bile leak, or peritonitis, except for 1 patient who had pneumoperitoneum. After EUS-guided transmural cholecystostomy, all patients showed rapid clinical improvement within 72 hours.
LIMITATIONS: Small number of patients.
CONCLUSION: EUS-guided transmural cholecystostomy may be feasible and safe as initial, interim, or even definitive treatment of patients with severe acute cholecystitis who are at high operative risk for immediate cholecystectomy.
Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
EUS-guided cholecystenterostomy: a new technique (with videos).
Kwan V, Eisendrath P, Antaki F, Le Moine O, Devière J
Gastrointest Endosc. 2007;66(3):582.
BACKGROUND: The cornerstone of management for acute cholecystitis is cholecystectomy. However, surgical intervention is contraindicated in the occasional patient. EUS-guided transduodenal gallbladder drainage may represent an effective minimally invasive alternative.
OBJECTIVES: To describe a new technique, EUS-guided cholecystenterostomy.
DESIGN AND SETTING: A single-center retrospective case series.
PATIENTS: Three patients with severe acute cholecystitis unresponsive to conservative management who were deemed unfit for cholecystectomy.
INTERVENTIONS: Under combined EUS and fluoroscopic guidance, cholecystenterostomy was performed via needle puncture, guidewire insertion, cystoenterostome passage, and stent placement.
MAIN OUTCOME MEASURES: Technical success, clinical progress, immediate and long-term complications, and recurrence of cholecystitis.
LIMITATIONS: Pilot series.
RESULTS: Cholecystenterostomy was performed successfully in all patients. Rapid improvement in clinical status and inflammatory parameters ensued. A minor intraprocedural bile leak occurred in 1 patient, without significant clinical sequelae. Cholecystitis did not recur in any patient.
CONCLUSIONS: EUS-guided cholecystenteric drainage is technically feasible and appears to be a safe and effective procedure. Via this technique, gallbladder drainage and resolution of related sepsis may be achieved in patients with acute cholecystitis who are unfit for surgery.
Department of Gastroenterology and Hepatology, Erasme Hospital, UniversitéLibre de Bruxelles, Brussels, Belgium.
Endoscopic transduodenal drainage of the gallbladder: implications for endoluminal treatment of gallbladder disease.
Baron TH, Topazian MD
Gastrointest Endosc. 2007;65(4):735.
Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.