key: cord-0987859-yjvsc6nv
authors: Di Mitri, Roberto; Mocciaro, Filippo; Amata, Michele; Bonaccorso, Ambra; Conte, Elisabetta; Scrivo, Barbara; Scimeca, Daniela
title: Rescue gallbladder drainage in very high-risk surgical patients with acute cholecystitis: Could COVID-19 patients be best suited for the EUS-guided approach?
date: 2021-10-13
journal: Gastrointest Endosc
DOI: 10.1016/j.gie.2021.05.025
sha: cc6007557ef444cf9e06da1948558a8716111b46
doc_id: 987859
cord_uid: yjvsc6nv

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Rescue gallbladder drainage in very high-risk surgical patients with acute cholecystitis: Could COVID-19 patients be best suited for the EUS-guided approach?

To the Editor:

We read with great interest the systematic review and network meta-analysis by Podboy et al, 1 comparing the efficacy of EUS-guided, endoscopic transpapillary, and percutaneous gallbladder drainage (GBD) in patients with acute cholecystitis and unfit for or with contraindications to surgical intervention.

Among the different strategies of salvage therapy proposed in this setting of nonsurgical patients, 2 many studies 3-5 and meta-analyses 6, 7 have shown that the EUSguided technique improved the outcomes in very highrisk patients, either as a bridge to surgery or as definitive therapy. Although each modality has its specific pros and cons and there was no single winner, the study by Podboy et al 1 concluded that endoscopic GBD should be preferred over percutaneous technique, choosing the EUS-guided approach in particular cases as definitive treatment, provided that adequate expertise in therapeutic EUS is available. 8 Moreover, the clinical scenario influences the choice of a specific technique and its outcome. 1 This issue is even more relevant during the current spreading SARS-CoV2 outbreak, 9 in which some cases of acute cholecystitis in the COVID-19 setting are reported and mainly treated with percutaneous drainage. 10 Critically ill COVID-19 patients certainly fall within the high-risk and unfit-forsurgery groups. In our experience, an elderly patient admitted to the intensive care unit for severe COVID-19 disease and concomitant septic acute cholecystitis underwent EUS-guided GBD by a lumen-apposing metal stent (Hot-Axios 15 Â 10 mm, Boston Scientific, Mass, USA) through a transgastric route; the procedure was performed at bedside with the use of personal protective equipment, under endoscopic and EUS guidance and without fluoroscopic assistance, and lasted 20 minutes.

High-risk surgical COVID-19 patients with concomitant acute cholecystitis could be best suited for EUS-guided GBD, in consideration of some advantages over the percutaneous approach, such as the lower rates of recurrent cholecystitis and reinterventions. 1 We suggest taking into account other pros such as the short procedure time and the absence of needing to move the patients and to equip operative and/or radiologic rooms. 

Comparison of EUS-guided endoscopic transpapillary and percutaneous gallbladder drainage for acute cholecystitis: a systematic review with network meta-analysis

Tokyo Guidelines 2018: management strategies for gallbladder drainage in patients with acute cholecystitis (with videos)

Endosonography-guided gallbladder drainage versus percutaneous cholecystostomy in very high-risk surgical patients with acute cholecystitis: an international randomised multicentre controlled superiority trial (DRAC 1)

EUS-guided gallbladder drainage in high-risk surgical patients with acute cholecystitis: procedure outcomes and evaluation of mortality predictors

EUS-guided gallbladder drainage versus laparoscopic cholecystectomy for acute cholecystitis: a propensity score analysis with 1-year follow-up data

Endoscopic ultrasound-guided gall-bladder drainage, transpapillary drainage, or percutaneous drainage in high risk acute cholecystitis patients: a systematic review and comparative meta-analysis

EUSguided versus endoscopic transpapillary gallbladder drainage in high-risk surgical patients with acute cholecystitis: a systematic review and meta-analysis

Time to face the facts: EUS gallbladder drainage is here to stay

ESGE and ESGENA position statement on gastrointestinal endoscopy and the COVID-19 pandemic

From the COVID-19 investigating and research team