Efficacy and Safety of Endoscopic Ultrasound-Guided Gallbladder Drainage (EUS-GBD) as Bridge Therapy in Resectable Pancreatic Neoplasms After Failed ERCP

Aims Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has been shown to be effective in managing malignant obstructive jaundice in unresectable cases after a failed endoscopic retrograde cholangiopancreatography (ERCP). However, its role as bridge therapy in potentially surgical patients remains uncertain [1]

Methods A retrospective analysis was conducted on patients with distal biliary neoplasms who underwent EUS-GBD between December 2022 and September 2024. Demographic data, obstruction etiology, procedural details, clinical success, and immediate adverse events were analyzed. Clinical success was defined as a reduction of>50% in baseline bilirubin levels within the first 48 hours and normalization within 30 days

Results Eight EUS-GBD procedures (three cholecysto-gastrostomies and five cholecysto-duodenostomies) were performed on six patients with pancreatic neoplasms and one patient with distal cholangiocarcinoma. The median age of the patients was 73 years. In five of the seven patients, ERCP was performed during the same session, while two required a staged approach. All patients were treated with lumen-apposing metal stents (LAMS) of 10x10 mm or 15x10 mm using a “free hand” technique. The mean gallbladder diameter was 41 mm, and the average procedure time was 11 minutes. One patient experienced post-ERCP pancreatitis, but no peri-procedural or subsequent adverse events were observed related to the EUS-guided drainage. Technical and clinical success was achieved in all cases. The mean time to surgery was 57 days. All patients subsequently underwent pylorus-preserving pancreaticoduodenectomy (Whipple procedure) without impacting surgical technique, achieving R0 margins in five patients and R1 margins in the other three.

Conclusions EUS-GBD following a failed ERCP serves as an effective and safe bridge therapy for biliary decompression in patients with potentially resectable pancreatic neoplasms, without negatively impacting subsequent surgical procedures

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

• References

• 1 Binda C, Anderloni A, Fugazza A. et al. EUS-guided gallbladder drainage using a lumen-apposing metal stent as rescue treatment for malignant distal biliary obstruction: a large multicenter experience. Gastrointest Endosc 2023; 98 (05): 765-773