PMID- 38155666
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20231230
IS  - 2296-858X (Print)
IS  - 2296-858X (Electronic)
IS  - 2296-858X (Linking)
VI  - 10
DP  - 2023
TI  - Current trends of minimally invasive therapy for cholecystocholedocholithiasis.
PG  - 1277410
LID - 10.3389/fmed.2023.1277410 [doi]
LID - 1277410
AB  - INTRODUCTION: The minimally invasive approach of endoscopic ultrasound 
      (EUS)-guided procedures for cholecystocholedocholithiasis, such as EUS-guided 
      gallbladder drainage (EUS-GBD), EUS-guided rendezvous (EUS-RV), and EUS-guided 
      biliary drainage (EUS-BD), is affirmed as an effective treatment for patients 
      with acute cholecystitis (AC) who are unfit for surgery and for patients with 
      common bile duct stones (CBDSs) who have experienced a previous ERCP failure. 
      Furthermore, in cases of difficult CBDS extraction during endoscopic retrograde 
      cholangiopancreatography (ERCP), cholangioscopy-guided electrohydraulic 
      lithotripsy (CS-EHL) has showed optimal results. The main objective of our study 
      was to evaluate the effectiveness of EUS-GBD and percutaneous gallbladder 
      drainage (PT-GBD) in patients with AC who are unfit for surgery. We also aimed to 
      evaluate the efficacy of EUS-GBD, EUS-BD, and EUS-RV following ERCP failure and 
      the effectiveness of CS-EHL for difficult CBDS extraction in our hospital. The 
      secondary aim was to examine the safety of these procedures. MATERIALS AND 
      METHODS: We conducted a retrospective evaluation of all the EUS-GBD, PT-GBD, 
      EUS-BD, EUS-RV, and CS-EHL procedures, which were prospectively collected in the 
      gastroenterology and digestive endoscopy unit and the general surgery unit from 
      January 2020 to June 2023. The efficacy was expressed in terms of technical and 
      clinical success rates, while safety was assessed based on the rate of adverse 
      events (AEs). RESULTS: We enrolled 83 patients with AC and high surgical risk. 
      Among them, 57 patients (68.7%, 24/57 male, median age 85 +/- 11 years) underwent 
      EUS-GBD, and 26 (31.3%, 19/26 male, median age 83 +/- 7 years) underwent PT-GBD. 
      The technical and clinical success rates were 96.5 and 100% for EUS-GBD, and 96.1 
      and 92% for PT-GBD. The AEs for EUS-GBD were 1.7%, and for PT-GBD, it was 12%. 
      ERCP for CBDS extraction failed in 77 patients. Among them, 73 patients (94.8%) 
      underwent EUS-RV with technical and clinical success rates of 72.6% (53/73) and 
      100%, respectively. No AEs were reported. Four out of 77 patients were directly 
      treated with EUS-BD for pyloric inflammatory stenosis. In 12 patients (16.4%), 
      following unsuccessful EUS-RV with a CBD diameter >/= 12 mm, an EUS-BD was 
      performed. Both technical and clinical success rates for EUS-BD were 100%, and no 
      AEs were reported. EUS-GBD was the treatment of choice for the remaining 8 
      (10.9%) patients after failure of both ERCP and EUS-RV. The procedure had high 
      technical and clinical success rates (both at 100%), and no AEs were reported. 
      The 12 difficult CBDS extraction treated with CS-EHL also showed high technical 
      and clinical success rates (both at 100%), with no reported AEs. CONCLUSION: The 
      minimally invasive approach for cholecystocholedocholithiasis, especially 
      EUS-guided procedures, had high efficacy and safety in treating AC in high-risk 
      surgical patients and CBDS extraction after a previously unsuccessful ERCP.
CI  - Copyright (c) 2023 Cominardi, Aragona, Cattaneo, Arzu, Capelli and Banchini.
FAU - Cominardi, Anna
AU  - Cominardi A
AD  - Gastroenterology and Digestive Endoscopy Unit, Hospital of Piacenza, Piacenza, 
      Italy.
FAU - Aragona, Giovanni
AU  - Aragona G
AD  - Gastroenterology and Digestive Endoscopy Unit, Hospital of Piacenza, Piacenza, 
      Italy.
FAU - Cattaneo, Gaetano
AU  - Cattaneo G
AD  - Emergency Surgery Unit, Hospital of Piacenza, Piacenza, Italy.
FAU - Arzu, Gian
AU  - Arzu G
AD  - Emergency Surgery Unit, Hospital of Piacenza, Piacenza, Italy.
FAU - Capelli, Patrizio
AU  - Capelli P
AD  - General Surgery Unit, Hospital of Piacenza, Piacenza, Italy.
FAU - Banchini, Filippo
AU  - Banchini F
AD  - General Surgery Unit, Hospital of Piacenza, Piacenza, Italy.
LA  - eng
PT  - Journal Article
DEP - 20231213
PL  - Switzerland
TA  - Front Med (Lausanne)
JT  - Frontiers in medicine
JID - 101648047
PMC - PMC10753828
OTO - NOTNLM
OT  - cholangioscopy
OT  - cholecystocholedocholithiasis
OT  - endoscopic retrograde cholangiopancreatography
OT  - endoscopic ultrasound-guided drainage
OT  - gallbladder drainage
COIS- The authors declare that the research was conducted in the absence of any 
      commercial or financial relationships that could be construed as a potential 
      conflict of interest.
EDAT- 2024/01/02 10:02
MHDA- 2024/01/02 10:03
PMCR- 2023/12/13
CRDT- 2023/12/29 03:35
PHST- 2023/08/14 00:00 [received]
PHST- 2023/11/09 00:00 [accepted]
PHST- 2024/01/02 10:03 [medline]
PHST- 2024/01/02 10:02 [pubmed]
PHST- 2023/12/29 03:35 [entrez]
PHST- 2023/12/13 00:00 [pmc-release]
AID - 10.3389/fmed.2023.1277410 [doi]
PST - epublish
SO  - Front Med (Lausanne). 2023 Dec 13;10:1277410. doi: 10.3389/fmed.2023.1277410. 
      eCollection 2023.