Endoscopic ultrasound-guided gallbladder and bile duct drainage with lumen apposing metal stent: a large multicentre cohort (with videos).

Abstract

Cholecystectomy and endoscopic retrograde cholangiopancreatography are the gold standard for managing acute cholecystitis and malignant biliary obstruction respectively. Recent advances in therapeutic endoscopic ultrasound (EUS) have provided alternatives for managing patients in whom these approaches fail, namely EUS-guided gallbladder drainage (EUS-GB) and EUS-guided bile duct drainage (EUS-BD). We aimed to assess the technical and clinical success of these techniques in the largest multi-centre cohort published to date. A retrospective, multi-centre, observational study involving 17 centres across Australia and New Zealand was conducted. All patients who had EUS-GB or EUS-BD performed in a participating centre using a lumen apposing metal stent (LAMS) between 2016 and 2020 were included. Primary outcome was technical success, defined as intra-procedural successful drainage. Secondary outcomes included clinical success and 30-day mortality. One hundred and fifteen patients underwent EUS-GB (n=49) or EUS-BD (n=66). EUS-GB was technically successful in 47 (95.9%) whilst EUS-BD was successful in 60 (90.9%). All failed cases were due to maldeployment of the distal flange outside of the targeted lumen. Clinical success of EUS-GB was achieved in 39 (79.6%). No patients required subsequent cholecystectomy. Clinical success of EUS-BD was achieved in 52 (78.8%). Thirty-day mortality was 14.3% for EUS-GB and 12.1% for EUS-BD. EUS-GB and EUS-BD are promising alternatives for managing non-surgical candidates with cholecystitis and malignant biliary obstruction following failed ERCP. Both techniques delivered high technical success with acceptable clinical success. Further research is needed to investigate the gap between technical and clinical success.