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• W3206720666 abstract "We read with great interest the systematic review and network meta-analysis by Podboy et al,1Podboy A. Yuan J. Stave C.D. et al.Comparison of EUS-guided endoscopic transpapillary and percutaneous gallbladder drainage for acute cholecystitis: a systematic review with network meta-analysis.Gastrointest Endosc. 2021; 93: 797-804Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar 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,2Mori Y. Itoi T. Baron T.H. et al.Tokyo Guidelines 2018: management strategies for gallbladder drainage in patients with acute cholecystitis (with videos).J Hepatobiliary Pancreat Sci. 2018; 25: 87-95Crossref PubMed Scopus (167) Google Scholar many studies3Teoh A.Y.B. Kitano M. Itoi T. 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. 2020; 69: 1085-1091Crossref PubMed Scopus (128) Google Scholar, 4Lisotti A. Linguerri R. Bacchilega I. et al.EUS-guided gallbladder drainage in high-risk surgical patients with acute cholecystitis: procedure outcomes and evaluation of mortality predictors.Surg Endosc. 2021; 28: 1-10Google Scholar, 5Teoh A.Y.B. Leung C.H. Tam P.T.H. et al.EUS-guided gallbladder drainage versus laparoscopic cholecystectomy for acute cholecystitis: a propensity score analysis with 1-year follow-up data.Gastrointest Endosc. 2021; 93: 577-583Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar and meta-analyses6Mohan B.P. Khan S.R. Trakroo S. et al.Endoscopic ultrasound-guided gall-bladder drainage, transpapillary drainage, or percutaneous drainage in high risk acute cholecystitis patients: a systematic review and comparative meta-analysis.Endoscopy. 2020; 52: 96-106Crossref PubMed Scopus (67) Google Scholar,7Krishnamoorthi R. Jayaraj M. Thoguluva Chandrasekar V. et al.EUS-guided versus endoscopic transpapillary gallbladder drainage in high-risk surgical patients with acute cholecystitis: a systematic review and meta-analysis.Surg Endosc. 2020; 34: 1904-1913Crossref PubMed Scopus (43) Google Scholar have shown that the EUS-guided technique improved the outcomes in very high-risk 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 al1Podboy A. Yuan J. Stave C.D. et al.Comparison of EUS-guided endoscopic transpapillary and percutaneous gallbladder drainage for acute cholecystitis: a systematic review with network meta-analysis.Gastrointest Endosc. 2021; 93: 797-804Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar 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.8Makar M. Tyberg A. Time to face the facts: EUS gallbladder drainage is here to stay.Gastrointest Endosc. 2021; 93: 805-806Abstract Full Text Full Text PDF Scopus (2) Google Scholar Moreover, the clinical scenario influences the choice of a specific technique and its outcome.1Podboy A. Yuan J. Stave C.D. et al.Comparison of EUS-guided endoscopic transpapillary and percutaneous gallbladder drainage for acute cholecystitis: a systematic review with network meta-analysis.Gastrointest Endosc. 2021; 93: 797-804Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar This issue is even more relevant during the current spreading SARS-CoV2 outbreak,9Gralnek I.M. Hassan C. Beilenhoff U. et al.ESGE and ESGENA position statement on gastrointestinal endoscopy and the COVID-19 pandemic.Endoscopy. 2020; 52: 483-490Crossref PubMed Scopus (247) Google Scholar in which some cases of acute cholecystitis in the COVID-19 setting are reported and mainly treated with percutaneous drainage.10Ying M. Lu B. Pan J. et al.From the COVID-19 investigating and research team. COVID-19 with acute cholecystitis: a case report.BMC Infect Dis. 2020; 20: 437Crossref PubMed Scopus (32) Google Scholar Critically ill COVID-19 patients certainly fall within the high-risk and unfit-for-surgery 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 × 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.1Podboy A. Yuan J. Stave C.D. et al.Comparison of EUS-guided endoscopic transpapillary and percutaneous gallbladder drainage for acute cholecystitis: a systematic review with network meta-analysis.Gastrointest Endosc. 2021; 93: 797-804Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar 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. Dr Di Mitri is a consultant for Boston Scientific. The other authors disclosed no financial relationships. ResponseGastrointestinal EndoscopyVol. 94Issue 5PreviewWe thank Di Mitri et al1 for their comments on our article.2 We agree that EUS-guided gallbladder drainage is also a good choice in the intensive care unit setting for critically ill patients who are intubated because of COVID-19 infection. Full-Text PDF" @default.
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• W3206720666 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?" @default.
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