NOT A SHOT IN THE DARK; THE IRISH EXPERIENCE OF EUS GUIDED GALLBLADDER DRAINAGE WITH THE HOT AXIOS STENT

Aims:

The management of gallbladder disease is particularly challenging in patients who are elderly or poor surgical candidates. Current standard of care for acute cholecystitis in this cohort involves antibiotics and possible percutaneous drainage via interventional radiology. External drains are uncomfortable, may dislodge, and can result in delayed hospital discharge or re-admission. We report the first 10 cases in Ireland of EUS guided placement of a lumen apposing metal stent between the gallbladder and stomach or duodenum using the hot AXIOS system.

Methods:

Nine patients with acute or recurrent cholecystitis and 1 patient with malignant biliary obstruction causing cholecystitis were prospectively selected as appropriate candidates. Each patient was deemed unsuitable for surgical intervention given advanced age or co-morbidities. Under conscious sedation in the endoscopy unit, EUS guided gallbladder drainage (EUS-GBD) was performed. Elective, interval stent removal was not planned given patient frailty. Time to follow up or death was calculated from medical records and clinical efficacy was assessed on patient review.

Results:

EUS- GBD was performed in 10 patients (mean age 79.5 years, range 65 – 95). Stent placement was successful in 100% of patients. 1 patient with advanced metastatic duodenal obstruction developed an aspiration pneumonia a few days post procedure and died. Another patient died of lung cancer 230 days post-procedure; otherwise all patients were alive and clinically improved at time study end. Mean time to follow up or death was 179 days (median 193 days).

Conclusions:

EUS- GBD in carefully selected patients is feasible, safe and may reduce the morbidity and long term care issues associated with percutaneous drains.