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Endoscopy 2021; 53(08): 827-831
DOI: 10.1055/a-1259-0349
Innovations and brief communications

Endoscopic ultrasound-guided gallbladder drainage as a rescue therapy for unresectable malignant biliary obstruction: a multicenter experience

Danny Issa
1   Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital and Weill Cornell Medical Center, New York, New York, USA
,
Shayan Irani
2   Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, USA
,
Ryan Law
3   Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
,
Shawn Shah
1   Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital and Weill Cornell Medical Center, New York, New York, USA
,
Sean Bhalla
2   Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, USA
,
Srihari Mahadev
1   Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital and Weill Cornell Medical Center, New York, New York, USA
,
Kaveh Hajifathalian
1   Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital and Weill Cornell Medical Center, New York, New York, USA
,
Kartik Sampath
1   Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital and Weill Cornell Medical Center, New York, New York, USA
,
Saurabh Mukewar
1   Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital and Weill Cornell Medical Center, New York, New York, USA
,
David L. Carr-Locke
1   Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital and Weill Cornell Medical Center, New York, New York, USA
,
Mouen A. Khashab
4   Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA
,
Reem Z. Sharaiha
1   Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital and Weill Cornell Medical Center, New York, New York, USA
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Abstract

Background Endoscopic retrograde cholangiopancreatography (ERCP) is often unsuccessful in patients with duodenal stenosis or malignant ampullary infiltration. While endoscopic ultrasound-guided biliary drainage (EUS-BD) has been proposed as an alternative, EUS-guided gallbladder drainage (EUS-GBD) is an attractive option when both approaches fail. We aimed to assess the effectiveness and safety of EUS-GBD as rescue therapy for malignant distal bile duct obstruction.

Methods A multicenter retrospective study was performed on patients with unresectable malignant distal bile duct obstruction who underwent EUS-GBD between 2014 and 2019 after unsuccessful ERCP and EUS-BD. Clinical success was defined as a decrease in serum bilirubin of > 50 % within 2 weeks.

Results 28 patients were included, with a lumen-apposing metal stent used in 26 (93 %) and a self-expandable metal stent in two (7 %). The technical success rate was 100 %. The clinical success rate was 93 %, with an improvement in bilirubin (7.3 [SD 5.4] pre-procedure vs. 2.8 [SD 1.1] post-procedure; P = 0.001). Delayed adverse events included food impaction of the stent (n = 3), with a further two patients developing cholecystitis and bleeding.

Conclusion This study demonstrates the feasibility of gallbladder drainage to relieve malignant distal bile duct obstruction in patients with failed ERCP and EUS-BD.



Publication History

Received: 05 June 2020

Accepted: 08 September 2020

Accepted Manuscript online:
08 September 2020

Article published online:
16 December 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

Letter to this article:

Endoscopic ultrasound-guided gallbladder drainage: a backdoor for biliary decompression?Endoscopy 2021; 53(08): 873-873
DOI: 10.1055/a-1299-1495

 

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