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EUS-guided gallbladder drainage in acute cholecystitis: response to letter to the editor
  1. Ji Young Bang1,
  2. Juan Pablo Arnoletti2,
  3. Andrew Wagner3,
  4. Shyam Varadarajulu1
  1. 1Digestive Health Institute, Orlando Health, Orlando, Florida, USA
  2. 2JPA Department of Surgical Oncolog, Orlando Health, Orlando, Florida, USA
  3. 3Department of Interventional Radiology, Orlando Health, Orlando, Florida, USA
  1. Correspondence to Dr Shyam Varadarajulu, Digestive Health Institute, Orlando Health, Orlando, Florida, USA; svaradarajulu{at}

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We thank the authors for their interest in our report on endoscopic ultrasound-guided gallbladder drainage (EUS-GBD).1 Management of gallbladder disease is not within the sole domain of gastroenterologists. It includes surgeons and interventional radiologists. When guidelines are developed without multidisciplinary consensus, problems can occur as reported in our series.2 The distinction between never-surgery and high-risk surgical patients is more than semantics. The former includes patients with end-stage lung disease such as pulmonary hypertension, irreversible severe vascular disease, end-stage cardiac disease in non-transplant patients, active inoperable malignancy and liver cirrhosis with portal hypertension. Performing EUS-GBD in this patient cohort is a no-brainer. In others, multidisciplinary consensus is critical.3

The multicentre case-control (1:2 match between EUS and percutaneous cohorts) study cited by authors in defence of EUS is retrospective, underpowered and does not stratify for disease severity.4 In …

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  • Contributors This response to the letter to the editor was composed by SV and JYB. JPA and AW performed critical revision of the response to the letter.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests JYB: consultant for Olympus America and Boston Scientific. SV: consultant for Boston Scientific, Olympus America and Medtronic. JPA and AW have no disclosures to declare.

  • Provenance and peer review Not commissioned; internally peer reviewed.