Prophylactic EUS-guided gallbladder drainage prevents acute cholecystitis in patients with malignant biliary obstruction and cystic duct orifice involvement: a randomized trial (with video) - 18/02/23
, Roberto Oleas, MD, Miguel Puga-Tejada, MD, Juan Alcivar-Vasquez, MD, Raquel Del Valle, MD, Juan Olmos, MD, Martha Arevalo-Mora, MD, Maria Egas-Izquierdo, MD, Daniela Tabacelia, MD, Jorge Baquerizo-Burgos, MD, Hannah Pitanga-Lukashok, MDAbstract |
Background and aims |
Patients with distal malignant biliary obstruction (MBO) and cystic duct orifice tumoral involvement have an increased risk for the development of acute cholecystitis after self-expandable metallic stent (SEMS) placement. We aimed to determine whether primary EUS-guided gallbladder drainage prevents acute cholecystitis in these patients.
Methods |
This was a single-center, randomized control trial in patients with distal MBO enrolled from July 2018 to July 2020. Patients were randomized into 2 groups: an interventional group treated with conventional ERCP biliary drainage with SEMS placement and subsequent primary EUS-guided gallbladder drainage (EUS-GBD) and a control group treated with conventional biliary drainage alone. The primary outcome of the study was the occurrence of post-treatment acute cholecystitis, assessed for ≤12 months or until death. The secondary outcomes were hospitalization length and median survival time.
Results |
Forty-four patients were included in the study: 22 in each group. Five patients in the control group (22.7%) and none in the intervention group experienced acute cholecystitis. The median hospitalization time was significantly lower in the interventional group than in the control group (2 days vs 1 day, P = .017). There was no difference in the observed median survival rates in the primary EUS-GBD group (2.9 months) and the control group (2.8 months) (P = .580).
Conclusion |
In this single-center study of patients with unresectable MBO and occlusion of the cystic duct orifice, prophylactic EUS-GBD demonstrated a reduced incidence of acute cholecystitis.
Il testo completo di questo articolo è disponibile in PDF.Abbreviations : EUS-GBD, MBO, OCD, SEMS
Mappa
| DISCLOSURE: Dr Robles-Medranda is a key opinion leader and consultant for Pentax Medical, Boston Scientific, Steris, Medtronic, Motus, Micro-tech, G-Tech Medical Supply, CREO Medical, mdconsgroup, and EndoSound. All other authors disclosed no financial relationships. |
Vol 97 - N° 3
P. 445-453 - marzo 2023 Ritorno al numero
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