Is the anesthesiologist still needed for endoscopic ultrasound gallbladder drainage?

Aims Endoscopic ultrasound gallbladder drainage (EUS-GBD) was reserved for high-surgical-risk patients. However, many of them showed a high-risk even for deep sedation. Our aim was to evaluate the safety and efficacy of EUS-GBD under conscious sedation (CS).

Methods All consecutive EUS-GBD under CS performed in our hospital were prospectively enrolled from January 2020 to December 2022. Patient characteristics, type and dosage of anesthetic drug administered (Fentanyl (FNT), Pethidine (PTD) or Benzodiazepine (BZD)), size of lumen-apposing-metal-stent (LAMS), gallbladder (GB) access, technical success, clinical success, early and late adverse events (AEs) rate were evaluated. Safety was defined as AEs occurrence. The efficacy of EUS-GBD was expressed as technical and clinical success.

Results 34 patients (41.7% male, mean age 82,9±10 years) underwent EUS-GBD under CS. In 30 (88.2%) EUS-GBD a 10x10mm LAMS was deployed, in 2 (5.9%) procedures a 15x10mm and in 2 (5.9%) an 8x8mm LAMS. GB was accessed from the stomach in 55.9% of cases. A combination of FNT+BZD was administered in 17 (50%) EUS-GBD, while 15 (44.1%) procedures were performed under PTD+BZD. Only 2 (5.9%) EUS-GBD were performed only under BZD. Mean FNT, PTD, BZD dose were 50(±11.5) mcg, 38.4(±25.6) mg and 4(±1.5) mg, respectively. Technical and clinical success were both of 97%. Only in 1(2.9%) EUS-GBD an early AE was reported. No late AEs were described. The administration of FNT+BZD or PTD+BZD or only BZD affected neither technical nor clinical success, nor AEs rate (p=0.28).

Conclusions EUS-GBD under CS was a safe procedure with a low AEs rate. The administration of FNT+BZD, PTD+BZD or BZD alone did not affect procedure outcome.

Publication History

Article published online:
14 April 2023