Cholelithiasis Clinical Trial
Official title:
Cholelithiasis Management: Elective Laparoscopic Cholecystectomy vs EUS-guided Gallbladder Cholecystostomy for Gallstones Clearance
In this new era of less invasive procedures, the indications for endoscopic ultrasound (EUS)-guided gallbladder drainage (GBD) are rapidly expanding. Nowadays, the standard treatment for uncomplicated cholelithiasis (symptomatic patients not requiring hospital admission or non-surgically managed during one or more hospital admissions) is elective laparoscopic cholecystectomy. To avoid the complications, difficulties and disadvantages of cholecystectomy, the investigators proposed a single-center study to determine the safety and effectiveness of EUS-guided GBD with electrocautery-enhanced lumen-apposing metal stent (LAMS) (Boston Scientific, Marlborough, MA, EEUU) with stone removal in patients with cholelithiasis, in comparison with the gold standard treatment, the elective laparoscopic cholecystectomy.
Status | Recruiting |
Enrollment | 56 |
Est. completion date | November 2, 2024 |
Est. primary completion date | October 2, 2024 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years to 89 Years |
Eligibility | Inclusion Criteria: - Adults >18 years old and <89 years old - Adult symptomatic patients with gallstones documented by US - Subject is a suitable candidate for an elective laparoscopic cholecystectomy or an EUS-guided GBD - Patients or authorized representative give informed consent for endoscopic or surgical approach Exclusion Criteria: - Patients with hepato-pancreato-biliary diseases other than gallstones (tumors, obstructions, inflammation) - Patients with acute cholecystitis, cholangitis or choledocholithiasis. - Patients with gallbladder polyps, family history of gallbladder cancer, or any other high-risk factor for gallbladder cancer - Patient unable to give informed consent or refuse to participate. - Prior biliary intervention - Pregnancy or nursing - Any other medical condition that contraindicates surgical or endoscopic procedures |
Country | Name | City | State |
---|---|---|---|
Ecuador | Instituto Ecuatoriano de Enfermedades Digestivas | Guayaquil | Guayas |
Lead Sponsor | Collaborator |
---|---|
Instituto Ecuatoriano de Enfermedades Digestivas |
Ecuador,
Du QC, Wang YY, Hu CL, Zhou Y. Reconsideration of indications for choledochoscopic gallbladder-preserving surgery and preventive measures for postoperative recurrence of gallstones. Wideochir Inne Tech Maloinwazyjne. 2020 Mar;15(1):87-96. doi: 10.5114/wiitm.2019.88647. Epub 2019 Oct 17. — View Citation
Flynn DJ, Memel Z, Hernandez-Barco Y, Visrodia KH, Casey BW, Krishnan K. Outcomes of EUS-guided transluminal gallbladder drainage in patients without cholecystitis. Endosc Ultrasound. 2021 Sep-Oct;10(5):381-386. doi: 10.4103/EUS-D-21-00040. — View Citation
Kamarajah SK, Karri S, Bundred JR, Evans RPT, Lin A, Kew T, Ekeozor C, Powell SL, Singh P, Griffiths EA. Perioperative outcomes after laparoscopic cholecystectomy in elderly patients: a systematic review and meta-analysis. Surg Endosc. 2020 Nov;34(11):4727-4740. doi: 10.1007/s00464-020-07805-z. Epub 2020 Jul 13. — View Citation
Radlinski MJ, Strand DS, Shami VM. Evolution of interventional endoscopic ultrasound. Gastroenterol Rep (Oxf). 2023 Jun 30;11:goad038. doi: 10.1093/gastro/goad038. eCollection 2023. — View Citation
Radunovic M, Lazovic R, Popovic N, Magdelinic M, Bulajic M, Radunovic L, Vukovic M, Radunovic M. Complications of Laparoscopic Cholecystectomy: Our Experience from a Retrospective Analysis. Open Access Maced J Med Sci. 2016 Dec 15;4(4):641-646. doi: 10.3889/oamjms.2016.128. Epub 2016 Nov 9. — View Citation
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Technical success after surgical and endoscopic intervention | Number of patients with correct placement LAMS or uneventful competition of laparoscopic cholecystectomy along with stone clearance. | Up to 6 hours | |
Primary | Resolution of biliary symptoms | Number of patients with clinical resolution based in a questionnaire for the assessment of biliary symptoms. | up to 12 months | |
Primary | Adverse events after the surgical procedures | The post-surgical adverse events will be assessed by the Clavien-Dindo classification | up to 14 days | |
Primary | Adverse events after the endoscopic procedures | The post-endoscopic adverse events will be assessed by the Adverse Events Gastrointestinal Endoscopy (AGREE) Classification | Up to 14 days | |
Secondary | 30-day major complications assessment | To assess the safety of the procedures the investigators will consider the 30-day major complication rate | up to 30 days | |
Secondary | Re-intervention rate | Number of patients that requires a re-intervention after an endoscopic or surgical procedure | 12-month follow-up |
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