Endoscopic ultrasound-guided gallbladder drainage. Which is the best way to access?

Aims Endoscopic ultrasound guided gallbladder drainage (EUS-GBD) with lumen apposing metal stent (LAMS) has become a favourite drainage option for high surgical-risk patients with acute cholecystitis and as rescue treatment for the relief of jaundice in patients with distal malignant biliary obstruction (DMBO) with high technical and clinical success. Both trans-gastric and trans-duodenal drainage are described but which is the best way is still controversial. We aim to compare the two different approaches in term of technical and clinical success, rate of adverse events, unplanned readmissions and re-interventions.

Methods Single center retrospective analysis of all consecutive cases of EUS-GBD with LAMS acceding to the Therapeutic Endoscopy Unit of Fondazione Policlinico Universitario Campus Bio-Medico of Rome. Data about LAMS features and procedure were collected.

Results From January 2019 to September 2024 sixty patients were enrolled (50% male; 77±12 years old). The 60% of them underwent EUS-GBD for acute cholecistitis. In 31/60 (52%) patients the trans-gastric access was performed. In 43/60 (71.7%) patients a Hot-Axios LAMS was used and in the majority of procedure (47/60 78.3%) a calibre bigger than 10 mm was used. In no case the LAMS was dilated. A naso-cistic tube was placed inside the LAMS in 31/60 patients. Regarding the adverse events rate, in one patient distal flange misdeployment occurred. LAMS obstruction occurred in 7/60 patients (11.7%) and need of reintervention in 10/60 (16.7%). There was no difference in term of drainage indication, technical success rate, type and size of LAMS used, naso-cystic tube insertion between the two different EUS-GBD access. The trans-gastric access was associated with a higher risk of LAMS obstruction (6/7 vs 1/7 p 0.05) and need of re-intervention (8/10 vs 2/10 p 0.03).

Conclusions Even with high technical success rate, EUS-GBD with trans-gastric access seems to be associated with a higher rate of late adverse events and when possible another way should be preferred.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025