Yakira David, Gaurav Kakked, Bradley Confer, Ruchit Shah, Harshit Khara, David L Diehl, Matthew Richard Krafft, Sardar M Shah-Khan, John Y Nasr, Petros Benias, Arvind Trindade, Thiruvengadam Muniraj, Harry Aslanian, Prabhleen Chahal, John Rodriguez, Douglas G Adler, Jason Dubroff, Rabi De Latour, Demetrios Tzimas, Lauren Khanna, Gregory Haber, Adam J Goodman, Nicholas Hoerter, Nishi Pandey, Mena Bakhit, Thomas E Kowalski, David Loren, Austin Chiang, Alexander Schlachterman, Jose Nieto, Ameya Deshmukh, Yervant Ichkhanian, Mouen A Khashab, Maan El Halabi, Richard S Kwon, Anoop Prabhu, Ariosto Hernandez-Lara, Andrew Storm, Tyler M Berzin, John Poneros, Amrita Sethi, Tamas A Gonda, Vladimir Kushnir, Natalie Cosgrove, Daniel Mullady, Abdullah Al-Shahrani, Lionel D'Souza, Jonathan Buscaglia, Juan Carlos Bucobo, Vineet Rolston, Prashant Kedia, Franklin Kasmin, Satish Nagula, Nikhil A Kumta, Christopher DiMaio
{"title":"超声内镜引导下置腔金属支架胆囊引流治疗急性胆囊炎的美国多中心疗效分析。","authors":"Yakira David, Gaurav Kakked, Bradley Confer, Ruchit Shah, Harshit Khara, David L Diehl, Matthew Richard Krafft, Sardar M Shah-Khan, John Y Nasr, Petros Benias, Arvind Trindade, Thiruvengadam Muniraj, Harry Aslanian, Prabhleen Chahal, John Rodriguez, Douglas G Adler, Jason Dubroff, Rabi De Latour, Demetrios Tzimas, Lauren Khanna, Gregory Haber, Adam J Goodman, Nicholas Hoerter, Nishi Pandey, Mena Bakhit, Thomas E Kowalski, David Loren, Austin Chiang, Alexander Schlachterman, Jose Nieto, Ameya Deshmukh, Yervant Ichkhanian, Mouen A Khashab, Maan El Halabi, Richard S Kwon, Anoop Prabhu, Ariosto Hernandez-Lara, Andrew Storm, Tyler M Berzin, John Poneros, Amrita Sethi, Tamas A Gonda, Vladimir Kushnir, Natalie Cosgrove, Daniel Mullady, Abdullah Al-Shahrani, Lionel D'Souza, Jonathan Buscaglia, Juan Carlos Bucobo, Vineet Rolston, Prashant Kedia, Franklin Kasmin, Satish Nagula, Nikhil A Kumta, Christopher DiMaio","doi":"10.1055/a-2495-5542","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and study aims: </strong>EUS-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.</p><p><strong>Patients and methods: </strong>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.</p><p><strong>Results: </strong>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, <i>P</i> = 0.04) and the occurrence of a LAMS-specific AE (OR 63.60, 95% CI 5.08-799.29, <i>P</i> <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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":11671,"journal":{"name":"Endoscopy International Open","volume":"13 ","pages":"a24955542"},"PeriodicalIF":2.2000,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11827723/pdf/","citationCount":"0","resultStr":"{\"title\":\"US multicenter outcomes of endoscopic ultrasound-guided gallbladder drainage with lumen-apposing metal stents for acute cholecystitis.\",\"authors\":\"Yakira David, Gaurav Kakked, Bradley Confer, Ruchit Shah, Harshit Khara, David L Diehl, Matthew Richard Krafft, Sardar M Shah-Khan, John Y Nasr, Petros Benias, Arvind Trindade, Thiruvengadam Muniraj, Harry Aslanian, Prabhleen Chahal, John Rodriguez, Douglas G Adler, Jason Dubroff, Rabi De Latour, Demetrios Tzimas, Lauren Khanna, Gregory Haber, Adam J Goodman, Nicholas Hoerter, Nishi Pandey, Mena Bakhit, Thomas E Kowalski, David Loren, Austin Chiang, Alexander Schlachterman, Jose Nieto, Ameya Deshmukh, Yervant Ichkhanian, Mouen A Khashab, Maan El Halabi, Richard S Kwon, Anoop Prabhu, Ariosto Hernandez-Lara, Andrew Storm, Tyler M Berzin, John Poneros, Amrita Sethi, Tamas A Gonda, Vladimir Kushnir, Natalie Cosgrove, Daniel Mullady, Abdullah Al-Shahrani, Lionel D'Souza, Jonathan Buscaglia, Juan Carlos Bucobo, Vineet Rolston, Prashant Kedia, Franklin Kasmin, Satish Nagula, Nikhil A Kumta, Christopher DiMaio\",\"doi\":\"10.1055/a-2495-5542\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and study aims: </strong>EUS-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.</p><p><strong>Patients and methods: </strong>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.</p><p><strong>Results: </strong>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, <i>P</i> = 0.04) and the occurrence of a LAMS-specific AE (OR 63.60, 95% CI 5.08-799.29, <i>P</i> <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%). 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引用次数: 0
摘要
背景和研究目的：eus引导下采用腔内金属支架（LAMS）进行胆囊引流（EUS-GBD）治疗急性胆囊炎（AC）具有良好的技术和短期临床成功。本研究的目的是确定EUS-GBD合并LAMS的长期临床结局和不良事件（ae）。患者和方法：在美国18所三级医疗机构进行了一项多中心、回顾性研究。纳入标准：任何伴有LAMS的伴有EUS-GBD的AC患者，术后随访至少30天。长期临床成功定义为急性胆囊炎（RAC）无复发bbb30天，长期AE定义为指数手术后bbb30天发生急性胆囊炎（RAC）。结果：共纳入109例患者。109例患者中技术成功108例（99.1%），初步临床成功106例（97.2%）。在中位随访140天（范围30-1188天）期间，109例患者中有98例（89.9%）获得长期临床成功。在多变量分析（MVA）中，无结石性胆囊炎（优势比[OR] 15.93, 95%可信区间[CI] 1.22-208.52, P = 0.04）和lams特异性AE的发生（优势比[OR] 63.60, 95% CI 5.08-799.29， P距指标程序30天）。大多数长期ae(109例中有7例；6.42%)为lam特异性。没有技术或临床因素与不良事件的发生相关。109例患者中有24例（22%）切除了LAMS。无论是否切除LAMS， RAC和ae均无差异。结论：EUS-GBD合并LAMS在AC患者中具有较高的长期临床成功率和适度的AE发生率，是高危手术候选人的合理目的地治疗。
US multicenter outcomes of endoscopic ultrasound-guided gallbladder drainage with lumen-apposing metal stents for acute cholecystitis.
Background and study aims: EUS-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.
Patients and methods: 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.
Results: 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.
Conclusions: 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.
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