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Endoscopy 2025; 57(06): 593-601
DOI: 10.1055/a-2517-0927
Original article

Safety and effectiveness of endoscopic ultrasound-guided gallbladder drainage in patients with cirrhosis: an international multicenter experience

Rajat Garg 
1   Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, United States
,
Todd H. Baron
2   Department of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, United States
,
Judy A. Trieu
2   Department of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, United States
,
Belén Martínez-Moreno 
3   Endoscopy Unit, ISABIAL, Hospital General University Dr. Balmis, Alicante, Spain
,
José Ramón Aparicio Tormo 
3   Endoscopy Unit, ISABIAL, Hospital General University Dr. Balmis, Alicante, Spain
,
Karl Akiki
4   Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, United States
,
Andrew C. Storm 
4   Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, United States
,
Prabhat Kumar
1   Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, United States
,
Amandeep Singh 
1   Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, United States
,
C. Roberto Simons-Linares
1   Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, United States
,
Prabhleen Chahal
5   Division of Gastroenterology, Hepatology and Nutrition, University of Texas Health, San Antonio, United States
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Abstract

Background

Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) for symptomatic gallbladder disease has been shown to be safe and effective in patients with high surgical risk, but data are lacking for patients with cirrhosis. We investigated the safety and effectiveness of EUS-GBD in patients with and without cirrhosis.

Methods

This retrospective review included patients who underwent EUS-GBD at four (three US and one Spanish) international tertiary care centers. Outcomes, including technical success, clinical success, and procedure-related adverse events, were compared between patients with and without cirrhosis.

Results

170 patients (47 with cirrhosis, 123 without cirrhosis) were included. There was no difference in age, sex, race, comorbidities, antiplatelet use, hemoglobin, or international normalized ratio between the two groups (P > 0.05 for all). The most common etiology of cirrhosis was alcohol (42.6%) with mean Model of End-stage Liver Disease-Sodium (MELD-Na) score of 16.2 (SD 8.8). Acute cholecystitis was more common in patients with cirrhosis (74.5% vs. 56.9%; P = 0.02). Technical (cirrhosis 97.9% vs. no cirrhosis 95.1%; P = 0.67) and clinical (93.6% vs. 94.9%; P = 0.71) success rates were similar in the two groups. Adverse events were infrequent and similar between groups, the most common being stent maldeployment (cirrhosis 4.3% vs. no cirrhosis 5.7%; P = 0.99). Survival rates were similar at the end of follow-up.

Conclusion

EUS-GBD was safe and effective in patients with cirrhosis, with outcomes similar to patients without cirrhosis when performed by experienced echoendoscopists. Patients with cirrhosis and symptomatic gallbladder disease can be considered for EUS-GBD.



Publication History

Received: 24 January 2024

Accepted after revision: 14 January 2025

Accepted Manuscript online:
15 January 2025

Article published online:
24 February 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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