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CC BY-NC-ND 4.0 · Endosc Int Open 2023; 11(11): E1063-E1068
DOI: 10.1055/a-2180-9817
Original article

Long-term results after EUS gallbladder drainage in high-surgical-risk patients with acute cholecystitis: A 3-year follow-up registry

Belen Martinez-Moreno 
1   Endoscopy Unit, Hospital General Universitario de Alicante, Alicante, Spain (Ringgold ID: RIN16802)
,
Gonzalo López-Roldán
1   Endoscopy Unit, Hospital General Universitario de Alicante, Alicante, Spain (Ringgold ID: RIN16802)
,
Juan Martínez-Sempere
1   Endoscopy Unit, Hospital General Universitario de Alicante, Alicante, Spain (Ringgold ID: RIN16802)
,
Enrique de-Madaria
2   Gastroenterology, Hospital General Universitario de Alicante, Alicante, Spain (Ringgold ID: RIN16802)
,
Rodrigo Jover
2   Gastroenterology, Hospital General Universitario de Alicante, Alicante, Spain (Ringgold ID: RIN16802)
,
José Ramón Aparicio 
2   Gastroenterology, Hospital General Universitario de Alicante, Alicante, Spain (Ringgold ID: RIN16802)
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Abstract

Background and study aims Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has become the favorite drainage option for high surgical-risk patients with acute cholecystitis. However, data on long-term outcomes regarding efficacy and security over 1 year are scarce.

Patients and methods We performed a retrospective review of a prospectively maintained database to analyze the 3-year long-term outcomes of EUS-GBD with lumen apposing metal stents (LAMS) in high-surgical-risk patients with acute cholecystitis.

Results Fifty patients with acute cholecystitis who underwent EUS-GBD with LAMS and 3-year follow-up or until death were included in this study. No endoscopic revisions were scheduled unless an adverse event (AE) or suspected LAMS dysfunction occurred. AEs occurred in 18%, 20%, and 26% of patients in the first, second, and third years, respectively. Thirteen patients developed at least one AE, and six presented with a second AE during follow-up. Recurrence of cholecystitis occurred in two patients (4%). Seven stent migrations (14%) occurred but all were asymptomatic. Symptomatic LAMS-related AEs (LAMS-RAEs) (37.5%) were related to gastric location of the stent compared with duodenal location (66.7% vs. 12.5%, P = 0.03). No stent-related bleeding or stent-related mortality was observed.

Conclusions EUS-GBD with LAMS without scheduled removal is an effective and safe long-term treatment in high-surgical-risk patients with acute cholecystitis. Late LAMS-RAEs tend to be more asymptomatic over time. Symptomatic LAMS-RAEs are associated with gastric location, and overall, AEs tend to recur.

Keywords

Endoscopic ultrasonography - Intervention EUS - Biliary tract


Publication History

Received: 07 July 2023

Accepted after revision: 21 September 2023

Accepted Manuscript online:
25 September 2023

Article published online:
10 November 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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