Aims Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has emerged as a promising
option in patients presenting with cholecystitis, deemed unfit for laparoscopic cholecystectomy.
Evidence from comparative trials is lacking on the best stent type to use for EUS-GBD.
This study aims to compare the outcomes between lumen-apposing metal stents (LAMS)
and double-pigtail plastic stents (DPPS) in EUS-GBD.
Methods We conducted a bicentric retrospective study on patients considered unfit for surgery
by an experienced surgeon, presenting with acute cholecystitis. This study reviewed
prospectively collected registries of all patients who underwent EUS-GBD using LAMS
or DPPS between 2012 and 2023 at two European tertiary care centers. Primary outcomes
included technical and clinical success (defined as symptom resolution 15 days post-intervention),
and adverse events (using AGREE classification). Secondary outcomes were the reintervention
rate, length of hospital stay, and 30-day mortality. Statistical non-parametric tests
or Chi-square tests were used for comparisons and Kaplan-Meier analysis for survival
and time-to-reintervention outcomes [1]
[2]
[3]
[4].
Results Among the 55 patients included (66.7% men, median age 68 years (IQR, 55-81), 37 and
18 were treated with LAMS and DPPS, respectively. Technical success was similar with
97.3% in the LAMS group and 94.4% in the DPPS group (p=1.00). No difference in clinical
success was observed (78.4% for LAMS and 66.7% for DPPS (p=0.542)). Adverse events
within 30 days (AGREE classification 1–5) were also similar, with a rate of 31.4%
for LAMS and 38.9% for DPPS (p=0.610). There was no statistically significant difference
in the occurrence of post-procedural peritonitis (16.7% LAMS vs. 8.3% DPPS, p=0.388)
or in 30-day mortality (20% LAMS vs. 27.8% DPPS, p=0.378). However, the incidence
of post-procedural septicemia was significantly higher in the DPPS group (38.9% for
DPPS vs. 8.3% for LAMS), without any impact on the post-intervention length of hospital
stay (6 vs 7 days, p=0.478). In terms of delayed complications (beyond 30 days), there
was no difference in recurrent acute cholecystitis (9.4% for LAMS vs 11.1% for DPPS;
p=1.00), stent migration (3.7% for LAMS vs 11.8% for DPPS; p=0.549), patency rates
(88.9% for LAMS vs 82.4% for DPPS; p=0.662), with similar reintervention rates (29.4%
for LAMS vs 38.9% for DPPS; p=0.54).
Conclusions This bicentric retrospective study is the first and largest to evaluate LAMS vs DPPS
in EUS-GBD. The results are similar in terms of technical and clinical success, adverse
events, and reintervention rates. We only observed a higher risk of post-procedural
septicemia in the DDPS group, without any impact on the post-procedure length of hospital
stay. Given the cost difference between the two stent types, our findings challenge
current recommendations for systematically favoring LAMS in this context.
