Efficacy and Safety of Eus-Guided Transmural Gallbladder Drainage In Malignant Biliary Obstruction Using an Electrocautery-Enhanced Lumen Apposing Metal Stent: a French Multicenter Study

Aims In case of malignant obstruction of the distal biliary duct, electrocautery-enhanced lumen apposing metal stent (EC-LAMS) allows either endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) or choledochoduodenostomy (EUS-CDS) if endoscopic retrograde cholangiopancreatography (ERCP) is not feasible. EUS-CDS is associated with less adverse events than EUS-HGS but can be challenging. Thus, a simple alternative would be welcomed. We aim to assess the efficacy and safety of EUS-guided transmural gallbladder drainage using an EC-LAMS in malignant distal biliary obstruction.

Methods We performed a French multicentric retrospective cohort study including adult patients with jaundice due to a malignant distal biliary obstruction who failed a previous ERCP (or ERCP was not possible), and who underwent EUS-guided transmural gallbladder drainage with an EC-LAMS. The primary outcome was the clinical success of the transmural gallbladder drainage using an EC-LAMS.

Results From July 2016 to July 2020, twenty-eight patients were included. Mean duration of follow-up from EC-LAMS procedure until last news was 3.6 +/- 5.0 months. Mean bilirubin value at inclusion was 185.5 +/- 146.2 umol/L. Etiology of biliary obstruction was as follows: pancreatic adenocarcinoma in 19 (67.9 %) patients, cholangiocarcinoma in 4 (14.2 %) patients, other malignancies in five (17.9 %) patients. Clinical success was obtained in 22 (78.6 %) patients, and technical success was achieved in all patients. No complication occurred during the procedure. Three patients (10.7 %) had an adverse event within 30 days after the procedure: one stent obstruction, one cholangitis, and one septic choc. During follow-up, 4 (14.3 %) patients underwent another biliary drainage for a recurrence of biliary event after a mean time of 25.8 +/- 19.9 days.

Conclusions In our study, EUS-guided transmural gallbladder drainage was clinically efficient in 78.6 % of the patients with malignant distal biliary obstruction with few adverse events. This technique could be considered in case of ERCP not feasible.

Citation: Lambin T, Branche J, Privat J et al. OP94 EFFICACY AND SAFETY OF EUS-GUIDED TRANSMURAL GALLBLADDER DRAINAGE IN MALIGNANT BILIARY OBSTRUCTION USING AN ELECTROCAUTERY-ENHANCED LUMEN APPOSING METAL STENT: A FRENCH MULTICENTER STUDY. Endoscopy 2021; 53: S40.

Publication History

Article published online:
19 March 2021