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

Belen Martinez-Moreno; Gonzalo López-Roldán; Juan Martínez-Sempere; Enrique de-Madaria; Rodrigo Jover; José Ramón Aparicio

doi:10.1055/a-2180-9817

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

Endosc Int Open. 2023 Nov 10;11(11):E1063-E1068. doi: 10.1055/a-2180-9817. eCollection 2023 Nov.

Authors

Belen Martinez-Moreno¹, Gonzalo López-Roldán¹, Juan Martínez-Sempere¹, Enrique de-Madaria², Rodrigo Jover², José Ramón Aparicio²

Affiliations

¹ Endoscopy Unit, Hospital General Universitario de Alicante, Alicante, Spain.
² Gastroenterology, Hospital General Universitario de Alicante, Alicante, Spain.

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: Biliary tract; Endoscopic ultrasonography; Intervention EUS.

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