Safety and clinical outcomes of endoscopic ultrasound-guided gallbladder drainage with lumen-apposing metal stents in patients with dwell time over one year

Abstract

Background: Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has proved effective in patients with cholecystitis at high surgical risk. The long-term risks of gallstone-related disease and stent-related adverse events are unknown. Methods: We performed a retrospective evaluation of a case series including subjects who underwent EUS-GBD using lumen-apposing metal stents (LAMS). Patients were identified from a prospective LAMS registry at a single tertiary center. Patients with a stent indwell time <1 year were excluded. Data regarding stent deployment and adverse events were retrieved from the prospective LAMS registry, while emergency room visits, admissions and causes of death were retrieved from electronic medical records. Results: We included 22 patients with a median age of 88.3 years (interquartile range [IQR]: 82.6-92.7), 14 (63.6%) were male. Median follow up was 24.4 months (IQR: 18.2-42.4) and median time to the last available imaging procedure was 607 days (IQR: 463-938). No LAMS-related adverse events were identified beyond the first year of follow up. During follow up, 12 patients (54.5%) visited the emergency room 34 times (1 visit/patient, IQR: 0-3) and a total of 36 hospital admissions were required, with a median of 1 admission/patient (IQR: 0-3). Fourteen (63.6%) patients died during follow up. Only 1 patient (4.5%) required new hospital admissions for gallstone-related disease. Conclusions: There were no adverse events beyond the first year after stent deployment, with only 4.5% of subjects requiring gallstone-related admissions. Permanent EUS-GBD with LAMS may be a definitive treatment for acute cholecystitis in patients ineligible for cholecystectomy.

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

“…Regarding migrations, we found a rate of 14% in our series, higher than other published series [4,5]. However, this is justified by most migrations occurring late in our series with a median This article is protected by copyright.…”

“…Some authors advocate removing the LAMS weeks after EUS-GBD to avoid long-term AEs associated with LAMS [4], similar to studies using LAMS in pancreatic fluid collection. In contrast, other authors have suggested indwelling LAMS, given the fragility of these patients [5].…”

Endoscopic Approaches to Cholecystitis

“…The most common adverse events reported after endoscopic intervention are stent malfunction, bleeding, and acute pancreatitis (with transpapillary stent placement). In addition to short-term adverse events, there are data reporting the long-term safety of EUS-GBD with LAMS in patients who are 2-3 years out from initial intervention suggesting that this technique can be used as a more permanent solution (11,12). When considering length of hospitalization, data suggest that the 2 endoscopic techniques lead to shorter hospital lengths of stay when compared with PTGBD.…”

<p>Endoscopic Ultrasound-Guided Gallbladder Drainage: Current Perspectives</p>

“…Recently, Yuste et al 28 have performed a retrospective evaluation of a case series including subjects who underwent EUS-GBD using LAMS, in order to evaluate the safety and clinical outcomes after at least 1 year of follow up. In this study, no LAMS-related AE were identified after the first 12 months of follow up, and only 4.5% of patients required re-admission for the gallstone-related disease.…”