Aims To study the long-term safety and efficacy of EUS-guided gallbladder drainage with
Lumen-apposing metal stent (LAMS) in non-surgical patients with acute cholecystitis
Methods A retrospective review was made from a prospective maintained data base.
Results We included 44 non-surgical patients from our center with acute cholecystitis and
EUS-GBD with 2-year follow-up or until death. Technical success: 100%, clinical success:98.1%.
Median follow-up: 607 days (127-1088). 32 patients died during follow-up:30-day mortality
11.1%, 1-year mortality 37% and 2-year mortality 46.3%). Eleven patients had a total
of 20 complications (37%): 25.9% after the first year, and 33% after 2 years. Complications:
9 biliary events (16.5%) in 6 patients after a median of 232 days (137-694): 6 cholangitis,
1 choledocholithiasis, 1 biliary colic, 1 hepatic abscess. The severity of biliary
events was mild (22.2%), moderate (44.2%) and severe (33.3%). Treatment was endoscopic
(78%), conservative (11%) and radiology (11%).
9 Patients had 11 complications related to the stent after a median of 116 (19-331)
days: 3 recurrence of cholecystitis, 4 migrations, 2 buried stents, 2 obstructions
to gastric emptying. The severity of stent-related complications was mild in 27.3%,
moderate in 18.2% and severe in 9% and treatment was endoscopic in 81.8% and conservative
in 18.2%.
Stent-related complications were significantly associated with the location of the
drainage: 35.7% in the stomach, and 10% from the duodenum (p: 0.041).
Conclusions After an EUS-GBD most complications occur in the first year, with no significant
increase in the second year. Stent-related complications are associated with drainage
from the stomach.
