EUS-GUIDED GALLBLADDER DRAINAGE: A VALUABLE OPTION IN THE COVID-19 ERA

Background and aim: In the beginning of 2020 COVID-19 pandemic rapidly affected every country and overwhelmed many healthcare systems. In 2020 in northern Italy, the first western country to be affected, the prevalence was high and it brought a burden beyond the capacity of hospitals to manage, particularly in intensive care units (ICUs) [1]. This experience has shown that intensive care and ventilator support may be needed for extended durations. Patients experience consequences of severe respiratory illness and post-intensive care illness. Endoscopic procedures, such as endoscopic ultrasound-guided gallbladder transmural drainage (EUSGBD), can reduce surgical interventions, intensive care admissions, and longterm complications. In accordance with Tokyo guidelines, laparoscopic surgical cholecystectomy is the best treatment for acute cholecystitis (AC). Alternatives for high-risk patients must be considered, since morbidity and mortality are not negligible, and the traditional alternative is percutaneous trans-hepatic gallbladder drainage. EUS-GBD is efficient and safe, with a low rate of adverse events. A 2016 systematic review by Anderloni and others that evaluated stent outcomes showed pooled technical and clinical success rates in 98.6% and 94.4% of cases, respectively. Materials and methods: A 54-year-old man who had been admitted to a rehabilitation unit after prolonged ICU hospitalization for severe COVID-19 pneumonia, was referred to the surgical unit for AC and sepsis. Medical therapy could not improve his condition, and he rapidly worsened. Results: Due to his recent ICU admission, further intubation was strongly discouraged. Following multidisciplinary evaluation, he was moved to the endoscopy suite for drainage. EUS-GBD was achieved using a 10x15-mm electrocautery-enhanced lumen-apposing metal stent (Video 1). Up to now his follow-up is regular and after prolonged rehabilitation he can be considered for elective surgery. Conclusions: The patient didn't experience any symptom related to recurrent cholecystitis nor long term complications. EUS-GBD is a valuable option in order to reduce surgical interventions and intensive-care admissions. The Covid-19 pandemic has prompted further use of interventional endoscopic ultrasound as an alternative to surgery.

Eus-guided gallbladder drainage to the rescue in a patient that recovered from covid-19

The COVID-19 pandemic has rapidly affected every country and overwhelmed many healthcare systems. Intensive caretreatment may be needed for extended durations. Patients experience consequences of respiratory illness and post-intensive care illness (1,2). Endoscopic procedures, such as endoscopic ultrasound-guided gallbladder transmural drainage, can reduce surgicalinterventions, intensive-care admissions, and long-term complications (3). EUS-guided gallbladder drainage is efficient and safe, with a low rate of adverse events. A 54-year-old man, recently recovered from severe COVID-19+ pneumonia and still judged unfit for futhher intubation, wastreated by EUS-guided gallbladder drainage for severe acute cholecistytis by a 10x15-mm electrocautery-enhanced lumen-apposing stent.