A233 CANADIAN EXPERIENCE OF ENDOSCOPIC ULTRASOUND-GUIDED GALLBLADDER DRAINAGE: A CASE SERIES
Notice bibliographique
Résumé
Abstract Background Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is an emerging treatment for acute cholecystitis in patients who are poor surgical candidates. There is a lack of EUS-GBD data in the Canadian setting, which may differ from its global counterparts in pattern of healthcare availability, aging population, and use of conscious sedation. Aims To describe outcomes following EUS-GBD in the Canadian setting. Methods The case series included patients undergoing EUS-GBD by an interventional gastrointestinal endoscopist in a tertiary academic centre in Canada. Data included were clinicodemographic information, procedural details, and clinical outcomes. Results From September 2023 to September 2024, a total of 18 patients underwent EUS-GBD. Median age was 85 (IQR 75-88) years, 6 (33%) were female, and 17 (94%) were American Society of Anesthesiologists Physical Status (ASA) classification III. Indication included 15 cases of acute calculous cholecystitis and 3 (17%) cases of salvage treatment for malignant biliary obstruction without alternative access. Placement was transduodenal in 10 (56%) and transgastric in 8 (44%). A coaxial double pigtail was placed in 15 cases (83%). Conscious sedation was used for 15 cases (83%), with 1 case using deep sedation with propofol and 2 with general anesthesia. All cases were technically successful followed by improvement of symptoms and biochemistry. There were no intra-procedural complications, but 3 post-procedural complications were noted. One patient had recurrent cholecystitis after 1 month due to stent occlusion despite coaxial pigtail placement, which was managed endoscopically with symptom resolution. Another patient had a buried stent, which was managed with placement of a second lumen-apposing metal stent within the first stent. A third patient had pain post-procedure suspected due to stent expansion, which self-resolved within 2 weeks. No rescue percutaneous or surgical interventions were required following EUS-GBD. No patients underwent subsequent cholecystectomy. Four patients died from underlying systemic disease, including 3 patients who underwent EUS-GBD for malignant obstruction with no recurrent cholecystitis up to time of death at 15-150 days post-procedure. Conclusions In an elderly population and using primarily conscious sedation, EUS-GBD was safe and effective in patients with high surgical risk, underscoring the suitability of this technique for a Canadian setting. A. Gallbladder with debris/sludge on EUS. B. Distal flange of lumen apposing metal stent (LAMS) deployed within gallbladder lumen. C. Proximal flange deployed in duodenum. D. Coaxial double pigtail placed within LAMS. Funding Agencies None
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,003 | 0,004 |
| Études des sciences et des technologies | 0,005 | 0,002 |
| Communication savante | 0,002 | 0,001 |
| Science ouverte | 0,001 | 0,002 |
| Intégrité de la recherche | 0,002 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».