Safety and efficacy of endoscopic ultrasound‐guided gallbladder drainage combined with endoscopic retrograde cholangiopancreatography in the same session

Abstract

Background and Aim: Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is an emerging option for acute cholecystitis in non-surgical candidates. Combining endoscopic retrograde cholangiopancreatography (ERCP) for common bile duct stones with EUS-GBD in a single session might become a non-surgical management strategy to comprehensively treat gallstone disease in selected patients. Methods:Single-center retrospective cohort study comparing outcomes between EUS-GBD alone (group A) and single-session ERCP combined with EUS-GBD (group B). Consecutive patients who underwent EUS-GBD with a lumen-apposing metal stent (LAMS) between June 2011 and August 2018 were analyzed. Exclusion criteria were subjects included in randomized clinical trials, patients who had had ERCP within 5 days of EUS-GBD, patients in whom ERCP or EUS-GBD was carried out for salvage of one or the other procedure, and patients who underwent concurrent EUS-guided biliary drainage. Results: One hundred and nine consecutive patients under-went EUS-GBD with LAMS during the study period. Seventy-one patients satisfied the inclusion criteria and 34 patients were in group A and 37 in group B. Baseline characteristics were similar in both groups. There were no significant differences in technical (97.1% vs 97.3%; P = 0.19) and clinical success rates (88.2% vs 94.6%; P = 0.42) of EUS-GBD in group A versus group B. Rate of adverse events was similar in both groups, five (14.7%) in group A versus five (13.5%) in group B. Conclusions:Single-session EUS-GBD combined with ERCP has comparable rates of technical and clinical success to EUS-GBD alone. A combined EUS-GBD and ERCP procedure does not appear to increase adverse events and makes possible comprehensive treatment of gallstone disease by purely endoscopic means.

Endoscopic Transpapillary Gallbladder Drainage for Recurrent Cholecystitis after Covered Self-expandable Metal Stent Placement for Unresectable Malignant Biliary Obstruction

“…Although EUS-GBD is currently a feasible option for the management of acute cholecystitis after SEMS placement, it may be considered only as an alternative to established interventions such as PTGBD or ETGBD because of the dearth of available dedicated devices and scarce evidence supporting the utility of the technique and its safety. More recently, the usefulness of EUS-GBD with a lumen-apposing metal stent (LAMS) in the management of cholecystitis in high-risk surgical patients has also been reported (20)(21)(22). Although the application of EUS-GBD with LAMS for the management of cholecystitis after SEMS placement requires further evaluation, this technique may be a viable option, considering the high technical success rate and the nature of internal drainage.…”

Endoscopic therapies for gallbladder drainage

“…Single-session EUS-guided GBD (EUS-GBD) combined with ERCP can also be considered, as a retrospective study did not demonstrate increased AEs of the same-session combined procedure compared with EUS-GBD alone. 9 EUS-GBD should also be considered in cases of cystic duct Endoscopic therapies for gallbladder drainage obstruction or large-volume cholelithiasis, although significant stone burden may similarly interfere with the endosonographic approach.…”

EUS and ERCP in the Same Session for Biliary Stones: From Risk Stratification to Treatment Strategy in Different Clinical Conditions

“…Lastly, EUS-guided gallbladder drainage (GBD) can be coupled to ERCP in non-surgical candidates [ 30 ]. We owe to the same Spanish group of the studies above the description of same session ERCP and EUS-GBD as a strategy to comprehensively treat gallstone disease in selected patients [ 31 ]. The technical and clinical success rates of the combined procedures were comparable to EUS-GBD alone, indicating that it is possible to combine EUS-GBD and ERCP without increasing adverse events as a comprehensive treatment of gallstone disease by purely endoscopic means.…”