EUS-GUIDED GALLBLADER DRAINAGE WITH LUMEN APPOSING METAL STENT: RESULTS OF A MULTICENTER STUDY

Aims In high-risk patients, EUS-guided gallbladder drainage (EUGBD) is a validated alternative to percutaneous transhepatic gallbladder drainage (PTGBD) based upon the 2018 Tokyo guidelines. The use of electrocautery-enhanced lumen-apposing metal stent (ECE-LAMS) have recently and rapidly disseminating into interventional EUS practice.

We report in this first french multicenter study the clinical outcomes of endoscopic ultrasound-guided gallbladder drainage with ECE-LAMS as a treatment for patients with acute cholecystitis and who are unfit for surgery.

Methods We performed a retrospective multicenter study between June 2014 and October 2019. EUGBD were executed under general anesthesia without endotracheal intubation and access was achieved directly and by using only EUS guidance. Data were collected on technical success (stent placement), clinical success (resolution of symptoms within 3 days) and adverse events.

Results EUGBD was performed in 84 patients (46 women) with a median age of 82 years old (range, 45-99), most with acalculous cholecystitis (n = 55; 66.5%). Stent placement was technically successful in 82 patients (97.5%). One of he failure case required immediate surgery. Resolution of cholecystitis was observed in 82 of 82 patients (100%). The medium time of procedure was 5 min (range, 3-30). There was 2 late adverse events (2%). No bleeding occured and no recurrence was observed with a median follow-up of 389 days (range, 3-1269). Removal of a ECE-LAMS was attempted successfully in one case at 3 months before a now possible cholecystectomy. The mean postprocedure pain score was 2/10. The length of stay in the hospital was 3 days (1-10).

Conclusions EUGBD technique appear as a feasible and efficient technique with similar results to thoses of the PTGBD. We also observe no stent migration and no recurrence of cholecystitis. Large comparative and prospective studies are needed.