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

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

• References

• 1 Das A, Sivak Jr MV. Endoscopic palliation for inoperable pancreatic cancer. Cancer Control 2000; 7: 452-457
• 2 Speer AG, Cotton PB, Russell RC. et al. Randomised trial of endoscopic versus percutaneous stent insertion in malignant obstructive jaundice. Lancet 1987; 2: 57-62
• 3 Tuca A, Guell E, Martinez-Losada E. et al. Malignant bowel obstruction in advanced cancer patients: epidemiology, management, and factors influencing spontaneous resolution. Cancer Manag Res 2012; 4: 159-169
• 4 Paik WH, Lee TH, Park DH. et al. EUS-guided biliary drainage versus ERCP for the primary palliation of malignant biliary obstruction: a multicenter randomized clinical trial. Am J Gastroenterol 2018; 113: 987-997
• 5 Park JK, Woo YS, Noh DH. et al. Efficacy of EUS-guided and ERCP-guided biliary drainage for malignant biliary obstruction: prospective randomized controlled study. Gastrointest Endosc 2018; 88: 277-282
• 6 Bishay K, Boyne D, Yaghoobi M. et al. Endoscopic ultrasound-guided transmural approach versus ERCP-guided transpapillary approach for primary decompression of malignant biliary obstruction: a meta-analysis. Endoscopy 2019; 51: 950-960
• 7 Kedia P, Sharaiha RZ, Kumta NA. et al. Endoscopic gallbladder drainage compared with percutaneous drainage. Gastrointest Endosc 2015; 82: 1031-1036
• 8 Luk SW, Irani S, Krishnamoorthi R. et al. Endoscopic ultrasound-guided gallbladder drainage versus percutaneous cholecystostomy for high risk surgical patients with acute cholecystitis: a systematic review and meta-analysis. Endoscopy 2019; 51: 722-732
• 9 Imai H, Kitano M, Omoto S. et al. EUS-guided gallbladder drainage for rescue treatment of malignant distal biliary obstruction after unsuccessful ERCP. Gastrointest Endosc 2016; 84: 147-151
• 10 Cotton PB, Eisen GM, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
• 11 McKay A, Abulfaraj M, Lipschitz J. Short- and long-term outcomes following percutaneous cholecystostomy for acute cholecystitis in high-risk patients. Surg Endosc 2012; 26: 1343-1351
• 12 Chung YH, Choi ER, Kim KM. et al. Can percutaneous cholecystostomy be a definitive management for acute acalculous cholecystitis?. J Clin Gastroenterol 2012; 46: 216-219
• 13 Chang JI, Dong E, Kwok KK. Endoscopic ultrasound-guided transmural gallbladder drainage in malignant obstruction using a novel lumen-apposing stent: a case series (with video). Endosc Int Open 2019; 7: E655-E661
• 14 Itoi T, Binmoeller K, Itokawa F. et al. Endoscopic ultrasonography-guided cholecystogastrostomy using a lumen-apposing metal stent as an alternative to extrahepatic bile duct drainage in pancreatic cancer with duodenal invasion. Dig Endosc 2013; 25 (Suppl. 02) 137-141
• 15 Nakai Y, Matsubara S, Isayama H. et al. Cystic duct patency in EUS-guided gallbladder drainage as a rescue treatment for malignant biliary obstruction. Gastrointest Endosc 2016; 83: 1302-1303