Comparison of the effectiveness and safety of lumen-apposing metal stents and anti-migrating tubular self-expandable metal stents for EUS-guided gallbladder drainage in high surgical risk patients with acute cholecystitis.

Abstract

BACKGROUND AND AIMS:

Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using an anti-migrating tubular self-expandable metal stent (ATSEMS) is performed in high surgical risk patients with acute cholecystitis. The newly introduced lumen-apposing metal stent (LAMS) is expected to reduce the risk of tubular self-expandable metal stent-related adverse events such as stent migration, but no comparative studies have been carried out between LAMSs and ATSEMSs for EUS-GBD.

METHODS:

We reviewed the prospectively collected EUS-GBD database at Asan Medical Center and Bucheon Soonchunhyang hospital to analyze consecutive patients with acute cholecystitis who underwent EUS-GBD with LAMSs or ATSEMSs between January 2015 and December 2017. Technical success, clinical success, adverse events, and recurrence of cholecystitis were evaluated.

RESULTS:

A total of 71 patients (36 with LAMSs, 35 with ATSEMSs) were analyzed. The LAMS group had longer median procedure time (15.5 minutes) than the ATSEMS group (11 minutes; P = .017). The 2 groups did not show significant differences in terms of technical success (LAMS, 94% vs ATSEMS, 100%; P = .49), clinical success (94% vs 100%; P = .49), procedure-related adverse events (0% vs 2.9%; P = .99), and stent-related late adverse events (11.8% vs 5.8%; P = .43). During follow-up, the 2 groups had similar rates of cholecystitis recurrence at 6 months (LAMS, 3.4% vs ATSEMS, 3.1%, P = .99) and 12 months (8.3% vs 3.1%, P = .56).

CONCLUSIONS:

In high surgical risk patients with acute cholecystitis, LAMSs and ATSEMSs for EUS-GBD showed similar rates of technical success, clinical success, procedure-related adverse events, stent-related late adverse events, and recurrence of cholecystitis.

• Authors: Sung Hyun Cho, Dongwook Oh, Tae Jun Song, Do Hyun Park, Dong-Wan Seo, Sung Koo Lee, Myung-Hwan Kim, Yun Nah Lee, Jong Ho Moon, Sang Soo Lee
• Journal: Gastrointestinal endoscopy (Gastrointest Endosc) Vol. 91 Issue 3 Pg. 543-550 (03 2020) ISSN: 1097-6779 [Electronic] United States
• PMID: 31629721 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2020. Published by Elsevier Inc.

Topics

• Aged
• Aged, 80 and over
• Cholecystitis, Acute (diagnostic imaging, surgery)
• Cholecystostomy (instrumentation)
• Drainage
• Duodenum (surgery)
• Endosonography
• Female
• Gallbladder (diagnostic imaging, surgery)
• Humans
• Male
• Prosthesis Failure
• Prosthesis Implantation (instrumentation)
• Retrospective Studies
• Self Expandable Metallic Stents
• Stents
• Stomach
• Surgery, Computer-Assisted
• Treatment Outcome