Endoscopic ultrasound-guided gallbladder drainage for jaundice: Response to Vanella et al.

IF 4.7 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Digestive Endoscopy Pub Date : 2024-07-25 DOI:10.1111/den.14886

Antoine Debourdeau, Diane Lorenzo

{"title":"Endoscopic ultrasound-guided gallbladder drainage for jaundice: Response to Vanella et al.","authors":"Antoine Debourdeau, Diane Lorenzo","doi":"10.1111/den.14886","DOIUrl":null,"url":null,"abstract":"We appreciate Vanella et al.'s insightful letter regarding our GALLBLADEUS study.1 They correctly noted that endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) may have appeared as a third-line option. Due to our retrospective data, we lack specific details, but in our center, EUS-GBD is often preferred over endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) after failed endoscopic retrograde cholangiopancreatography, with many patients receiving EUS-GBD as a second-line treatment.We fully agree with Vanella's remark that the presence of duodenal stenosis makes the use of EUS-CDS inappropriate. However, the patients included in this study were treated at a time when this information had not yet been published, particularly by the CABRIOLET trial2 conducted by our correspondents. The proportion of patients with duodenal stenosis was significant but comparable in both groups (48.7% EUS-CDS vs. 41.5% EUS-GBD). However, despite this, our study still showed that dysfunctions seemed less frequent in the EUS-GBD group.Emerging evidence suggests hepaticogastrostomy as a better route for duodenal stenosis,2, 3 although it has a longer learning curve compared to EUS-GBD, which is simpler for less-experienced centers. Our study suggests fewer dysfunctions with EUS-GBD vs. EUS-CDS in this context, a finding that needs confirmation from future prospective, comparative studies as suggested by Vanella et al. We agree that biliary drainage far from the tumor warrants comparing EUS-GBD to hepaticogastrostomy. The significant proportion of duodenal stenosis in our study favors EUS-GBD, suggesting fewer dysfunctions, although this needs confirmation by future studies. This question is of interest because EUS-GBD is simpler for less-experienced centers and could be more widely adopted than hepaticogastrostomy. Future prospective studies comparing EUS-CDS, EUS-GBD, and hepaticogastrostomy across various clinical scenarios are essential. We thank Vanella et al. for their valuable input and look forward to further dialogue and research in this evolving field.Authors declare no conflict of interest for this article.","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 1","pages":"131"},"PeriodicalIF":4.7000,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11718123/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Digestive Endoscopy","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/den.14886","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

We appreciate Vanella et al.'s insightful letter regarding our GALLBLADEUS study.¹ They correctly noted that endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) may have appeared as a third-line option. Due to our retrospective data, we lack specific details, but in our center, EUS-GBD is often preferred over endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) after failed endoscopic retrograde cholangiopancreatography, with many patients receiving EUS-GBD as a second-line treatment.

We fully agree with Vanella's remark that the presence of duodenal stenosis makes the use of EUS-CDS inappropriate. However, the patients included in this study were treated at a time when this information had not yet been published, particularly by the CABRIOLET trial² conducted by our correspondents. The proportion of patients with duodenal stenosis was significant but comparable in both groups (48.7% EUS-CDS vs. 41.5% EUS-GBD). However, despite this, our study still showed that dysfunctions seemed less frequent in the EUS-GBD group.

Emerging evidence suggests hepaticogastrostomy as a better route for duodenal stenosis,^{2, 3} although it has a longer learning curve compared to EUS-GBD, which is simpler for less-experienced centers. Our study suggests fewer dysfunctions with EUS-GBD vs. EUS-CDS in this context, a finding that needs confirmation from future prospective, comparative studies as suggested by Vanella et al. We agree that biliary drainage far from the tumor warrants comparing EUS-GBD to hepaticogastrostomy. The significant proportion of duodenal stenosis in our study favors EUS-GBD, suggesting fewer dysfunctions, although this needs confirmation by future studies. This question is of interest because EUS-GBD is simpler for less-experienced centers and could be more widely adopted than hepaticogastrostomy. Future prospective studies comparing EUS-CDS, EUS-GBD, and hepaticogastrostomy across various clinical scenarios are essential. We thank Vanella et al. for their valuable input and look forward to further dialogue and research in this evolving field.

Authors declare no conflict of interest for this article.

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

内镜超声引导胆囊引流术治疗黄疸：对 Vanella 等人的回应

我们感谢Vanella等人对我们GALLBLADEUS研究的深刻见解他们正确地指出，超声内镜引导胆囊引流术（EUS-GBD）可能已经作为第三线选择出现。由于我们的回顾性数据，我们缺乏具体的细节，但在我们的中心，内镜逆行胆管造影失败后，EUS-GBD通常比超声内镜引导的胆总管十二指肠吻合术（EUS-CDS）更受欢迎，许多患者接受EUS-GBD作为二线治疗。我们完全同意Vanella的观点，即十二指肠狭窄的存在使得EUS-CDS的使用不合适。然而，本研究中纳入的患者是在该信息尚未发表的时候接受治疗的，特别是由我们的记者进行的CABRIOLET试验2。两组十二指肠狭窄患者的比例显著但相似（EUS-CDS 48.7% vs. EUS-GBD 41.5%）。然而，尽管如此，我们的研究仍然表明，功能障碍在EUS-GBD组中似乎较少发生。越来越多的证据表明，肝胃造口术是治疗十二指肠狭窄的更好途径，尽管与EUS-GBD相比，它有更长的学习曲线，对于经验不足的中心来说更简单。我们的研究表明，在这种情况下，EUS-GBD与EUS-CDS的功能障碍较少，这一发现需要在未来的前瞻性比较研究中得到证实，如Vanella等人所建议的那样。我们同意远离肿瘤的胆道引流值得将EUS-GBD与肝胃造口术进行比较。在我们的研究中，十二指肠狭窄的显著比例有利于EUS-GBD，表明功能障碍较少，尽管这需要进一步的研究证实。这个问题很有趣，因为EUS-GBD对于经验不足的中心来说更简单，比肝胃造口术更广泛采用。未来的前瞻性研究比较EUS-CDS、EUS-GBD和肝胃造口术在各种临床情况下是必要的。我们感谢Vanella等人提供的宝贵意见，并期待在这一不断发展的领域进行进一步的对话和研究。作者声明本文不存在利益冲突。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Digestive Endoscopy 医学-外科

CiteScore

10.10

自引率

15.10%

发文量

291

审稿时长

6-12 weeks

期刊介绍： Digestive Endoscopy (DEN) is the official journal of the Japan Gastroenterological Endoscopy Society, the Asian Pacific Society for Digestive Endoscopy and the World Endoscopy Organization. Digestive Endoscopy serves as a medium for presenting original articles that offer significant contributions to knowledge in the broad field of endoscopy. The Journal also includes Reviews, Original Articles, How I Do It, Case Reports (only of exceptional interest and novelty are accepted), Letters, Techniques and Images, abstracts and news items that may be of interest to endoscopists.