HOT AXIOS Gallbladder Drainage

EUS-guided Gallbladder Drainage Clinical Evidence

EUS-guided Gallbladder Drainage Clinical Evidence

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International Guidelines on Acute Cholecystitis ManagementGallbladder drainage clinical evidence

These guidelines provide key recommendations for the management of acute cholecystitis highlighting the standard and emerging practices, including laparoscopic cholecystectomy and endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) tailored to the needs of patients who may not be suitable for traditional surgical interventions.

World Society of Emergency Surgery (WSES) Guidelines:

The 2020 WSES guidelines emphasize early laparoscopic cholecystectomy as the standard of care for acute cholecystitis. However, they acknowledge the role of gallbladder drainage, including the use of LAMS, in high-risk patients1.

European Society of Gastrointestinal Endoscopy (ESGE):

ESGE guidelines endorse endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using LAMS as an alternative to percutaneous cholecystostomy in high-risk surgical patients2.

Tokyo Guidelines:

The Tokyo Guidelines also support the use of EUS-GBD with LAMS for high-risk patients who are not suitable candidates for surgery2.

Comparative Benefits of Hot AXIOS™ EUS-GBD over Percutaneous Gallbladder Drainage (PT-GBD)

In this randomised multicentre controlled superiority trial, EUS-guided gallbladder drainage (EUS-GBD) offered significant advantages over percutaneous transhepatic gallbladder drainage (PT-GBD)3 :

GBD infograph

In multiple studies, EUS-GBD demonstrated significantly fewer adverse events compared to PT-GBD4,5,6,7,8,9,10.

In another study, patients undergoing EUS-GBD conversion also experienced lower rates of recurrent acute cholecystitis (p=0.012) and unplanned readmissions due to gallstone-related diseases (p=0.022) compared to those receiving conservative treatment11.

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Enabling efficient and effective treatment procedures

Learn more about Hot AXIOS in the management of acute cholecystitis; optimizing the patient pathway for these patients and the healthcare team specialists’ collaborative efforts in providing optimal care for patients.

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Hot AXIOS™ Gallbladder Drainage​

Learn more about Hot AXIOS™ Stent and Electrocautery-Enhanced Delivery System. Explore the benefits and the implantation steps of this innovative technology.

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Gallbladder Drainage Patient Pathway Optimization

Learn about the role of multidisciplinary team (MDT) in optimizing the patient pathway for acute cholecystitis.

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1.Sartelli, Massimo, et al. “2020 WSES Guidelines for the Management of Acute Cholecystitis.” World Journal of Emergency Surgery, vol. 15, no. 1, 2020, pp. 1-24.

2.Dumonceau, Jean-Marc, et al. “Endoscopic Ultrasound-Guided Gallbladder Drainage: ESGE Technical Review.” Endoscopy, vol. 54, no. 1, 2022, pp. 1-15.1-year adverse events: 25.6% vs 77.5% (p<0.001)

3.Teoh, A.Y.B., et al. “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).” Gut, vol. 69, 2020, pp. 1085-1091. doi:10.1136/gutjnl-2019-319996.

4.Boregowda, U., Chen, M., and Saligram, S. “Endoscopic Ultrasound-Guided Gallbladder Drainage versus Percutaneous Gallbladder Drainage for Acute Cholecystitis: A Systematic Review and Meta-Analysis.” Diagnostics, vol. 13, 2023. doi:10.3390/diagnostics13040657.

5.Cucchetti, A., et al. “Trial Sequential Analysis of EUS-Guided Gallbladder Drainage versus Percutaneous Cholecystostomy in Patients with Acute Cholecystitis.” Gastrointestinal Endoscopy, vol. 95, 2022, pp. 399-406. doi:10.1016/j.gie.2021.09.028.

6.Hemerly, M.C., et al. “Endoscopic Ultrasound (EUS)-Guided Cholecystostomy versus Percutaneous Cholecystostomy (PTC) in the Management of Acute Cholecystitis in Patients Unfit for Surgery: A Systematic Review and Meta-Analysis.” Surgical Endoscopy, vol. 37, 2023, pp. 2421-2438. doi:10.1007/s00464-022-09712-x.

7.Luk, S.W.Y., et al. “Endoscopic Ultrasound-Guided Gallbladder Drainage versus Percutaneous Cholecystostomy for High Risk Surgical Patients with Acute Cholecystitis: A Systematic Review and Meta-Analysis.” Endoscopy, vol. 51, 2019, pp. 722-732. doi:10.1055/a-0929-6603.

8.Lyu, Y., et al. “Endoscopic Ultrasound-Guided Gallbladder Drainage Versus Percutaneous Transhepatic Gallbladder Drainage for Acute Cholecystitis with High Surgical Risk: An Up-to-Date Meta-Analysis and Systematic Review.” Journal of Laparoendoscopic & Advanced Surgical Techniques, vol. 31, 2021, pp. 1232-1240. doi:10.1089/lap.2020.0786.

9.Cho, S.H., et al. “Long-Term Outcomes of Endoscopic Ultrasound-Guided Gallbladder Drainage versus In Situ or Ex Situ Percutaneous Gallbladder Drainage in Real-World Practice.” Digestive Endoscopy, vol. 35, 2023, pp. 658-667. doi:10.1111/den.14485.

10.Siddiqui, A., et al. “Three-Way Comparative Study of Endoscopic Ultrasound-Guided Transmural Gallbladder Drainage Using Lumen-Apposing Metal Stents versus Endoscopic Transpapillary Drainage versus Percutaneous Cholecystostomy for Gallbladder Drainage in High-Risk Surgical Patients with Acute Cholecystitis: Clinical Outcomes and Success in an International, Multicenter Study.” Surgical Endoscopy, vol. 33, 2019, pp. 1260-1270. doi:10.1007/s00464-018-6406-7.

11.Chon, H.K., Kim, S.H., and Kim, T.H. “Endoscopic Gallbladder Drainage Conversion versus Conservative Treatment Following Percutaneous Gallbladder Drainage in High-Risk Surgical Patients.” Gut and Liver, vol. 18, 2024, pp. 348-357. doi:10.5009/gnl230019.

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