Endoscopic Ultrasound-Guided Gallbladder Drainage Is Potentially a Safer and Efficacious Treatment of Choice in High-Risk Patients, as Opposed to Percutaneous Transhepatic Gallbladder Drainage

Abstract

Introduction: Endoscopic ultrasound-guided gall bladder drainage (EUS-GBD) is a promising technique for the treatment of acute cholecystitis and other biliary pathologies in patients who are high risk and not surgical candidates. The conventional treatment modality for these types of patients is percutaneous transhepatic gall bladder drainage (PTGBD). However, this procedure can cause major complications such as bleeding, infection and dislodgment. EUS-GBD has recently gained favor for its potential for minimal risks and increased efficacy. The aim of this study is to not only evaluate the safety and efficacy of EUS-GBD, but to also compare it to PTGBD, which is the current standard of care for these high risk patients. Methods: We retrospectively analyzed all of the patients who underwent Hot-AXIOS stent placement for gall bladder drainage over the last 1.5 years. We also obtained the age and gender matched cohort of a similar number of patients over the same period who underwent percutaneous cholecystostomy. We compared the technical success (success in gall bladder drain), clinical success (resolution of acute cholecystitis), adverse events and recurrence of cholecystitis. Continuous variables were calculated using a paired t-test and categorical variables were measured using Fisher's exact test. All measurements were performed using the R-statistical software. Results: A total of 11 patients underwent EUS-GBD compared to 11 patients who underwent PTGBD over the same time period. Baseline characteristics were similar between the two groups except for the ASA score, which was higher in EUS-GBD (Table-1). The median follow-up was 4 months (range 3-19 months). Clinical and technical successes were similar between the two groups. The risk of adverse events was similar between the two groups, however, the risk of acute cholecystitis recurrence was higher in PGBD group. Conclusion: The technical and clinical success of EUS-GBD is as good as PTGBD in patients who are high risk surgical patients with acute cholecystitis. Additionally, EUS-GBD is as safe as PGBD. EUS-GBD shows a trend for lower risk of recurrence of cholecystitis compared to PGBD.793_A Figure 1. Baseline characteristics793_B Figure 2. Outcomes