USE OF CT IMAGING TO PREDICT SUCCESS OF ENDOSCOPIC ULTRASOUND GUIDED GALLBLADDER DRAINAGE

Aims:

Endoscopic ultrasound guided endoluminal gallbladder drainage is an evolving treatment for patients with gallbladder disease. The procedure is usually performed in patients medically unfit for surgery. Currently there are no predictive models to determine the likelihood of success of the procedure. Our study proposes a scoring system using CT imaging to determine eligibility for the procedure.

Methods:

This is a retrospective examination of 150 sequential CT scans with contrast of the abdomen performed between January 2015 and March 2015. Images were assessed using non-diagnostic monitors with a web based PACS system browser (Sectra, Linköping, Sweden). The gallbladder was identified (when present) and its closest relationship to the stomach and duodenum was quantified using on-line measuring tools. A scoring system (CT assisted score- CTAS score) relating area to breadth was devised to create a numerical value inversely proportional to favorability, with a score of 1 being the most favorable.

Results:

Of the 150 scans reviewed, 100 scans were included in the analysis. Sixty-three demonstrated preferential approximation of the gallbladder to the duodenum. Sole gastric approximation was observed in only two patients. The CTAS ranged from 1 to 36, with 54 scans being 1, predicting success. The duodenal bulb was the most frequently approximated to the gallbladder wall compared to the second portion of the duodenum or gastric antrum.

Conclusions:

The CT assisted score may be a valuable tool to predict candidacy for endoscopic ultrasound guided endoluminal gallbladder drainage. Accessing the gallbladder from the duodenal bulb is preferential.