Interventional Approaches to Gallbladder Disease

Baron, Todd H.; Grimm, Ian S.; Swanstrom, Lee L.

doi:10.1056/nejmra1411372

Cited by 98 publications

(70 citation statements)

References 50 publications

(42 reference statements)

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“…The median (IQR) lesion size was 3.5 cm (2)(3)(4)(5), and 140 (80.9%) were located in the rectum. Overall, 49.7% were granular-type laterally spreading tumours (LST), 19.7% were non-granular LST, and 30.6% were polypoid lesions.…”

Section: Resultsmentioning

confidence: 99%

PTH-050 Radiofrequency ablation and argon plasma coagulation endoscopic treatment for symptomatic radiation proctitis to improve anaemia

Penman

Henry

2018

Endoscopy

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Section: Resultsmentioning

confidence: 99%

PTH-050 Radiofrequency ablation and argon plasma coagulation endoscopic treatment for symptomatic radiation proctitis to improve anaemia

Penman

Henry

2018

Endoscopy

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“…EUS-GBD is comparable to percutaneous drainage in terms of decreased complications and lower rates of re-intervention, catheter migration and repeat procedures in cases where cholecystectomy is contraindicated. 6 Technically, the new procedure is more challenging in terms of the gall bladder localization (floating, fixed to undersurface of liver or adhesions) and its status as a mobile organ. The other concern is the thickness of the gall bladder wall, which is thin compared to a bile duct or pancreatic fluid collections, so any forceful manipulation on the wall opposite of the puncture could lead to wall rupture or trauma.…”

Section: Discussionmentioning

confidence: 99%

“…The usual indications of percutaneous gall bladder drainage are advanced age, unfit for surgery status, advanced malignancies, failed medical therapy, lower bile duct obstruction with patent upper bile duct and hepatic duct, and poor surgical candidate status. 6 …”

Section: Discussionmentioning

confidence: 99%

EUS-guided Gall Bladder Drainage in Severe Liver Disease: A Single-center Experience in Critically Ill Cirrhotics

Jamwal

Sharma

Maiwall

et al. 2017

Journal of Clinical and Translational Hepatology

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Background and Aims: Acute calculous cholecystitis with impending gall bladder perforation in severe liver diseases including decompensated cirrhosis and acute-on-chronic liver failure (ACLF) is difficult to manage, due to the procedures such as cholecystectomy and per cutaneous cholecystostomy being associated with high risk and complications in these patients.Methods: Four cases of severe liver disease with acute calculous cholecystitis who presented to the Institute of Liver and Biliary Sciences (New Delhi, India) for further management were included in the study if they underwent endoscopic ultrasound-guided gall bladder drainage (EUS-GBD). The patients were followed up for a minimum of 3 months and outcomes were recorded.Results: Four cases of severe liver disease (three ACLF and one decompensated cirrhosis), with model for end-stage liver disease scores of 24, 26, 23 and 25 respectively, presented with acute calculous cholecystitis (Tokyo grade III) and systemic sepsis (high total leukocyte counts). Their international normalized ratios were 2.3, 2.6, 2.2 and 2.9 respectively, and two were in shock, requiring inotropes at presentation. Ultrasonography of the abdomen confirmed hugely distended gall bladder with stone impacted at the neck and moderate ascites. All these cases underwent EUS-GBD by linear echo endoscope, and had the gastric wall punctured in the antrum using a 19G access needle followed by dilatation of the tract using controlled radial expansion balloon and Sohendra dilator. In three cases, the plastic stents were placed. In the fourth case, a Nagi stent was placed. All the patients recovered and were discharged within a week.Conclusions: EUS-GBD is challenging in severe liver disease but represents a life-saving procedure, and hence can be attempted in such critically ill patients with utmost care and precaution.

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“…The safety and efficacy of EUS-GBD have been reported in several pooled analyses with technical and clinical success rates as high as 97% and 99%, respectively, when including all stent types (plastic, SEMS, and LAMS). [ 9 10 11 12 ] The relatively high adverse event rate of 8% was largely driven by early occlusion of plastic stents and high migration rates of covered SEMS that can result in bile leaks. [ 13 ] Data on EUS drainage using LAMS alone, have similar high efficacy with fewer complications reported in most series than that seen with plastic stents and SEMS.…”

Section: Eus-guided Gallbladder Drainagementioning

confidence: 99%