| Autor: |
Garcia Alonso, Francisco Javier, Bazaga, Sergio, Martinez-Ortega, Antonio, Sanchez-Ocana, Ramon, Grajal, Raquel, Ramon Aparicio, Jose, Martinez-Moreno, Belen, Jose Vila, Juan, De La Serna-Higuera, Carlos, Cobreros, Marina, Perez-Miranda, Manuel |
| Předmět: |
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| Zdroj: |
Gut & Liver; 2024 Supplement, Vol. 18, p128-128, 1/2p |
| Abstrakt: |
Background/Aims Thirty percent of patients with choledocholitiasis who undergo ERCP without subsequent cholecystectomy will suffer recurrent biliary events. EUS-guided gallbladder drainage (EUS-GBD) in the same endoscopic procedure might decrease this risk. Methods Multicenter randomized clinical trial (NCT03921502). Subjects >75 years of age with Charlson comorbidity index≥4 and symptomatic choledocholithiasis scheduled for ERCP were eligible. Participants were randomized to ERCP vs ERCP+EUS-GBD. A 1-year follow-up was scheduled. The primary outcome was hospital readmission due to gallstone related disease adverse events. Overall survival, all cause admissions, adverse events and quality of life were also evaluated. Kaplan-Meier curves and log-rank tests were used. Results A total of 74 patients have been included, 37 subjects/group, (49.3% of sample size). Baseline characteristics (table 1) were balanced. Median age was 89.5 (IQR: 85.6-91.7) years, 49 (66.2%) were female, median CCI was 6 (IQR: 4-7). EUS-GBD was performed using 10x10mm (25 patients, 67.6%) and 15x10mm (12 patients, 32.4%) LAMS. Median post-procedure hospital stay was 3 (IQR 2-5) days (ERCP) and 3 (2-6) days (ERCP+EUS-GBD).The 1-year biliary readmission risk was higher in the ERCP (27.5% [95% CI: 14.3-48.9%]) than in the ERCP+EUS-GBD group (5.7% [1.5-20.8%]) (fig 1). In the ERCP+EUS-GBD group 2 (5.4%) patients were readmitted (moderately severe sphincterotomy related bleedings). In the ERCP group 8 (21.6%) were readmitted (3 acute cholecystitis, 3 acute cholangitis and 2 scheduled cholecystectomies due to ongoing biliary pain).No differences were observed in mortality (ERCP: 12.6% [4.9-30.3%] vs ERCP+EUS-GBD: 23.1% [11-44.5%], p=0.61) or the all-cause admission risk (33.5% (19.1-54.4%) vs 36.3% (22.9-54.2%), p=0.40). Adverse events rates were 13.5% (ERCP) and 16.2% (ERCP+EUS-GBD). Conclusion Adding an EUS-GBD to the ERCP reduces the risk of subsequent gallstone related admissions, without an increased risk of adverse events or a longer hospital admission. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
| Externí odkaz: |
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