Endoscopic Ultrasound-guided Gallbladder Drainage Successful for Non-Cholecystitis Indications
Key findings
- This retrospective study compared the technical and clinical success of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) in 41 patients with acute cholecystitis and 15 who had non-cholecystitis indications for the procedure
- There was 100% technical success in all patients and the two groups had similar clinical success, with few complications within 14 days
- There were no late complications, such as stent migration or occlusion, in the non-cholecystitis group
- Length of hospital stay, readmissions for recurrent biliary disease, stent removal and reintervention rates, and mortality were also similar between the two groups
- EUS-GBD can be considered an alternative decompression method in patients with non-cholecystitis gallbladder or biliary disease
Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has recently emerged as a primary option for patients with acute cholecystitis who aren't candidates for surgery. It's also used as an alternative drainage method in patients converting from failed percutaneous cholecystostomy.
Subscribe to the latest updates from Digestive Health Advances in Motion
Duncan J. Flynn, MD, a clinical fellow in the Department of Medicine at Massachusetts General Hospital, Kumar Krishnan, MD, gastroenterologist in the Division of Gastroenterology, and colleagues have demonstrated substantial potential for the use of EUS-GBD in non-cholecystitis gallbladder and biliary disease as well. Their report appears in Endoscopic Ultrasound.
Methods
The team retrospectively reviewed a Mass General Division of Gastroenterology database for the period January 2015 through April 2020. They identified 56 EUS-GBD procedures: 41 performed for acute cholecystitis and 15 for non-cholecystitis indications.
The latter included symptomatic biliary colic, malignant biliary obstruction without cholecystitis, prevention of gallstone pancreatitis and secondary prevention of gallstone-related complications in patients with choledocholithiasis.
Primary Outcomes
- Technical success (defined as successful deployment of lumen-apposing metal stents and visualization of biliary flow)—100% in both the cholecystitis group and the non-cholecystitis group
- Immediate complications (within 14 days of the procedure)—14.6% vs. 13.3% (P=0.90); all were managed medically or endoscopically
- Late complications within one year—10% vs. 0% (P=0.22)
Secondary Outcomes
- Length of stay—11.6 vs. 9.3 days (P = 0.56)
- Stent removal—39% vs. 60% (P=0.17)
- Readmissions for recurrent biliary disease within one year—12.2% vs. 13.3% (P=0.91)
- Reintervention required within one year—19.5% vs. 26.7% (P=0.57)
- Death within one year—20% and 20%; no deaths were procedure-related
Patient Selection
The technical success rate in this study reflects only attempted cases. EUS-GBD is impractical or dangerous for some patients because of a decompressed gallbladder, anatomical variations or other reasons.
The risks and limitations of EUS-GBD itself must be considered on a patient-by-patient basis. The procedure requires a skilled endoscopic ultrasonographer, and there may be difficulty in distending a typically contracted gallbladder in nonobstructive cases, difficulty puncturing a thick gallbladder wall, increased risk in patients with ascites, and difficulty deploying a stent in a patient with a large gallstone due to space constraints.
view original journal article Subscription may be required
Visit the Digestive Healthcare Center
Refer a patient to the Digestive Healthcare Center