166 SAFETY AND EFFICACY OF EUS-GUIDED GALLBLADDER DRAINAGE (EUS-GBD) COMBINED WITH ERCP IN THE SAME SESSION

Abstract

ERCP is increasingly being combined in a single-session with other endoscopic procedures such as EUS (staging, screening for CBD stones, rendezvous for failed cannulation) duodenal stenting or cholangioscopy. EUS-guided gallbladder drainage (EUS-GBD) is an emerging option for acute cholecystitis in non-surgical candidates. Patients with acute cholecystitis often need CBD stone removal. Combination of ERCP for CBD stones and EUS-GBD might be appealing in some patient subsets, but there is virtually no objective evidence to support this combined approach to gallstone disease. To assess the safety and efficacy of EUS-GBD combined with ERCP in the same session. Single-center retrospective cohort study comparing outcomes of EUS-GBD alone to those of ERCP combined with EUS-GBD in the same session between June 2011 and May 2017. Lumen-apposing metal stent (LAMS, Axios®) were used in both groups. Exclusion criteria: ERCP or EUS-GBD used for salvage of one another (ie, transcystic GB drainage after failed EUS-GBD or EUS-GBD for failed biliary drainage at ERCP), EUS-guided biliary drainage (EUS-BD) in the same session, and ERCP within 5 days (before/after) EUS-GBD. Epidemiologic, procedural, and clinical outcome data were analyzed with Wilcoxon, Chi-square and Fisher tests where appropriate. Primary endpoints were rates of technical success, clinical success and adverse events. Sixty four consecutive patients underwent EUS-GBD between June 2011 and May 2017. 18 Patients were excluded: in 11 the indication for either ERCP or EUS-GBD was salvage of a failed tandem procedure, 5 had EUS-guided biliary drainage in the same session and a further 3 had another ERCP within 5 days of the index procedure. Forty five patients met inclusion/exclusion criteria: 24 EUS-GBD and 21 EUS-GBD combined with ERCP. Baseline characteristics were comparable in both groups. There were no significant differences in technical (100% vs 91.7%) and clinical success rates (90.5% vs 91.7%) of EUS-GBD in the combined versus the single procedure groups. The rate of adverse events (19.8% vs 20.9%) and the rate of technical issues (14.3% vs 37.5%; p=0.10) during LAMS deployment were also comparable. Results are detailed in Table 1. Technical success of ERCP was 100%. Details of ERCP are described in Table 2. While ERCP combined with EUS-GBD maintains similar rates of technical and clinical success to EUS-GBD alone, a combined procedure does not appear to increase adverse events. Despite the limitations of our study, these findings are encouraging and warrant further evaluation before this therapeutic approach can be generalized.Tabled 1Table 1.EUS-GBD+ERCP (n=21)EUS-GBD (n=24)pMedian age (IQR)85.3 (78-89)83.9 (78.6-89.9)0.70Male, n (%)10 (47.6%)13 (54.2%)0.66Baseline disease1-Benign, n (%)18 (85.7%)20 (83.3%)-Malignant, n (%)3 (14.3%)4 (16.7%)Indication24 (100%)0.21-Cholecystitis, n (%)19 (90.5%)-Coledocolithiasis, n (%)1 (4.8%)-Biliary decompression1 (4.8%)Technical issues during LAMS deployment, n (%)3 (14.3%)9 (37.5%)0.10Adverse events, n (%)4 (19.8%)5 (20.9%)1Clinical success, n (%)19 (90.5%)22 (91.7%)1Technical success, n (%)21(100%)22(91.7%)0.49 Open table in a new tab Tabled 1Table 2.Total (n=21)Indicacion-Cholecystitis, n (%)8 (38.1%)-Cholangitis, n (%)3 (14.3%)-Coledocholithiasis, n (%)6 (28.6%)-Benign stricture, n (%)1 (4.8%)-Malignant stricture, n (%)3 (14.3%)Sphincterotomy, n (%)17 (81%)Stone extraction, n (%)17 (81%)Precut, n (%)4 (19.1%)Biliary stent, n (%)5 (23.8%)Pancreatic stent, n (%)2 (11.1%) Open table in a new tab