PMID- 31475226
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20201001
IS  - 2364-3722 (Print)
IS  - 2196-9736 (Electronic)
IS  - 2196-9736 (Linking)
VI  - 7
IP  - 9
DP  - 2019 Sep
TI  - EUS-guided gallbladder drainage in patients with cirrhosis: results of a 
      multicenter retrospective study.
PG  - E1099-E1104
LID - 10.1055/a-0965-6662 [doi]
AB  - Background and study aims  Cirrhosis has historically been considered a relative, 
      if not absolute, contraindication to cholecystectomy. Endoscopic 
      ultrasound-guided gallbladder drainage (EUS-GBD) has been developed for use in 
      non-operative candidates with cholecystitis; however, little data exist for use 
      of the procedure in patients with cirrhosis. Patients and methods  This was a 
      retrospective series involving two large tertiary referral centers performing 
      EUS-GBD. Patients with cirrhosis who underwent EUS-GBD for cholecystitis between 
      August 2014 and December 2018 were identified. The primary endpoint was the rate 
      of technical success, defined as EUS-guided placement of a lumen-apposing metal 
      stent (LAMS) from duodenum to gallbladder. Patient demographics, procedural 
      details, adverse events (AEs), post-procedural symptoms, and clinical success 
      were recorded. Results  Fifteen patients (9 females, 6 males) with cirrhosis 
      underwent EUS-GBD during the study period. Mean patient age was 61 +/- 17.1yrs, 
      mean MELD-Na 15 +/- 7. Etiology of cirrhosis was HCV (n = 2), alcohol (n = 4), 
      non-alcoholic fatty liver disease (n = 8), and autoimmune hepatitis (n = 1). The 
      technical success rate was 93.3 % and mean procedure time was 64 +/- 59 minutes. 
      Initial puncture site was duodenum (n = 11), stomach (n = 3) and jejunum (n = 1) 
      and portion of gallbladder used for drainage was neck (n = 4) and body (n = 11). 
      Fourteen patients went on to clinical success and two AEs occurred in this 
      cohort. One decompensation event occurred in a patient with Child-Pugh class C 
      disease 3 weeks post-procedure. Mean length of follow-up was 373 +/- 367.3 days; 
      one death occurred due to underlying malignancy. Conclusion  EUS-GBD is safe and 
      efficacious in managing cholecystitis in patients with Child-Pugh A and B 
      cirrhosis who are non-operative candidates. Further studies are needed to 
      determine optimal patient selection and procedural technique.
FAU - James, Theodore W
AU  - James TW
AD  - University of North Carolina, Division of Gastroenterology & Hepatology, Chapel 
      Hill, North Carolina, United States.
FAU - Krafft, Matthew
AU  - Krafft M
AD  - West Virginia Ruby Memorial Hospital Digestive Diseases, Morgantown, West 
      Virginia, United States.
FAU - Croglio, Michael
AU  - Croglio M
AD  - University of North Carolina, Department of Medicine, Chapel Hill, North 
      Carolina, United States.
FAU - Nasr, John
AU  - Nasr J
AD  - West Virginia Ruby Memorial Hospital Digestive Diseases, Morgantown, West 
      Virginia, United States.
FAU - Baron, Todd
AU  - Baron T
AD  - University of North Carolina, Division of Gastroenterology & Hepatology, Chapel 
      Hill, North Carolina, United States.
LA  - eng
PT  - Journal Article
DEP - 20190829
PL  - Germany
TA  - Endosc Int Open
JT  - Endoscopy international open
JID - 101639919
PMC - PMC6715426
COIS- Competing interests Dr. Baron is a consultant and speaker for Boston Scientific, 
      W.L. Gore, Cook Endoscopy, and Olympus America.
EDAT- 2019/09/03 06:00
MHDA- 2019/09/03 06:01
PMCR- 2019/09/01
CRDT- 2019/09/03 06:00
PHST- 2019/03/25 00:00 [received]
PHST- 2019/06/12 00:00 [accepted]
PHST- 2019/09/03 06:00 [entrez]
PHST- 2019/09/03 06:00 [pubmed]
PHST- 2019/09/03 06:01 [medline]
PHST- 2019/09/01 00:00 [pmc-release]
AID - 10.1055/a-0965-6662 [doi]
PST - ppublish
SO  - Endosc Int Open. 2019 Sep;7(9):E1099-E1104. doi: 10.1055/a-0965-6662. Epub 2019 
      Aug 29.