Citations 2
US multicenter outcomes of endoscopic ultrasound-guided gallbladder drainage with lumen-apposing metal stents for acute cholecystitis
David, Yakira , Kakked, Gaurav, Confer, Bradley , Shah, Ruchit N. , Khara, Harshit S. , Diehl, David L. , Krafft, Matthew , Shah-Khan, Sardar M. , Nasr, John , Benias, Petros C. , Muniraj, Thiruvengadam , Aslanian, Harry R., Chahal, Prabhleen , Rodriguez, John , DuBroff, Jason, Latour, Rabi De, Khanna, Lauren , Haber, Gregory , Hoerter, Nicholas A. , Pandey, Nishi , Bakhit, Mena , Kowalski, Thomas E., Loren, David E. , Chiang, Austin , Schlachterman, Alexander , Nieto, Jose , Ichkhanian, Yervant , Khashab, Mouen A. , Halabi, Maan El , Kwon, Richard S. , Hernandez-Lara, Ariosto, Poneros, John M., Sethi, Amrita, Gonda, Tamas A. , Kushnir, Vladimir , Cosgrove, Natalie , Mullady, Daniel , Al-Shahrani, Abdullah , Buscaglia, Jonathan M. , Bucobo, Juan Carlos , Rolston, Vineet S. , Kedia, Prashant , Kasmin, Franklin, Kumta, Nikhil A. , DiMaio, Christopher J. , Krafft, Matthew Richard , Trindade, Arvind J. , Adler, Douglas G. , Tzimas, Demetrios J. , Goodman, Adam J. , Nieto, José , Deshmukh, Ameya A. , Prabhu, Anoop , Storm, Andrew C. , Berzin, Tyler M. , Sethi, Amrita , D'Souza, Lionel S. , Nagula, Satish
Endoscopy International Open | January 13, 2025 | Volume: 13 | Issue: CP | Pages: No page available
AbstractEUS-guided gallbladder drainage (EUS-GBD) using lumen apposing metal stents (LAMS) has excellent technical and short-term clinical success for acute cholecystitis (AC). The goals of this study were to determine the long-term clinical outcomes and adverse events (AEs) of EUS-GBD with LAMS.A multicenter, retrospective study was conducted at 18 US tertiary care institutions. Inclusion criteria: any AC patient with attempted EUS-GBD with LAMS and minimum 30-day post-procedure follow-up. Long-term clinical success was defined as absence of recurrent acute cholecystitis (RAC) > 30 days and long-term AE was defined as occurring > 30 days from the index procedure.A total of 109 patients were included. Technical success was achieved in 108 of 109 (99.1%) and initial clinical success in 106 of 109 (97.2%). Long-term clinical success was achieved in 98 of 109 (89.9%) over a median follow-up of 140 days (range 30–1188). On multivariable analysis (MVA), acalculous cholecystitis (odds ratio [OR] 15.93, 95% confidence interval [CI] 1.22–208.52, P = 0.04) and the occurrence of a LAMS-specific AE (OR 63.60, 95% CI 5.08–799.29, P <0.01) were associated with RAC. AEs occurred in 38 of 109 patients (34.9%) at any time, and in 10 of 109 (9.17%) > 30 days from the index procedure. Most long-term AEs (7 of 109; 6.42%) were LAMS-specific. No technical or clinical factors were associated with occurrence of AEs. LAMS were removed in 24 of 109 patients (22%). There was no difference in RAC or AEs whether LAMS was removed or not.EUS-GBD with LAMS has a high rate of long-term clinical success and modest AE rates in patients with AC and is a reasonable destination therapy for high-risk surgical candidates.
A Multicenter, Prospective Study of a New Fully Covered Expandable Metal Biliary Stent for the Palliative Treatment of Malignant Bile Duct Obstruction
Petersen, Bret T. , Kahaleh, Michel , Kozarek, Richard A. , Loren, David E. , Gupta, Kapil , Kowalski, Thomas E., Freeman, Martin L. , Chen, Yang K., Branch, M. Stanley, Edmundowicz, Steven A. , Glück, Michael , Binmoeller, Kenneth F., Baron, Todd H. , Kinney, Timothy P., Ross, William A., Jowell, Paul S., Carr‐Locke, David L. , Shah, Raj J. , Kahaleh, Michel , Edmundowicz, Steven A
Gastroenterology Research and Practice | March 27, 2013 | Volume: 2013 | Issue: No issue available | Pages: 1-7
Background and Study Aims. Endoscopic placement of self-expanding metal stents (SEMSs) is indicated for palliation of inoperable malignant biliary obstruction. A fully covered biliary SEMS (WallFlex Biliary RX Boston Scientific, Natick, USA) was assessed for palliation of extrahepatic malignant biliary obstruction.Patients and Methods. 58 patients were included in this prospective, multicenter series conducted under an FDA-approved IDE. Main outcome measurements included (1) absence of stent occlusion within six months or until death, whichever occurred first and (2) technical success, need for reintervention, bilirubin levels, stent patency, time to stent occlusion, and adverse events.Results. Technical success was achieved in 98% (57/58), with demonstrated acute removability in two patients. Adequate clinical palliation until completion of followup was achievedin 98% (54/55) ofevaluablepatients, with 1 reintervention due to stent obstruction after 142 days. Mean total bilirubin decreased from 8.9 mg/dL to 1.2 mg/dL at 1 month. Device-related adverse events were limited and included 2 cases of cholecystitis. One stent migrated following radiation therapy.Conclusions. The WallFlex Biliary fully covered stent yielded technically successful placement with uncomplicated acute removal where required, appropriate reduction in bilirubin levels, and low rates of stent migration and occlusion. This SEMS allows successful palliation of malignant extrahepatic biliary obstruction.