Su1300 OUTCOMES OF ENDOSCOPIC ULTRASOUND-GUIDED TRANSLUMINAL GALLBLADDER DRAINAGE IN PATIENTS WITHOUT CHOLECYSTITIS

Abstract

Cholecystectomy is the gold standard for most gallbladder related disease. However, many patients with gallbladder disease are poor surgical candidates. Current non-surgical gallbladder drainage (GBD) methods include percutaneous GBD, endoscopic transpapillary GBD with endoscopic retrograde cholangiopancreatography (ERCP), and endoscopic ultrasound-guided transluminal GBD (EUS-GBD). The success rates and adverse events for these methods have been documented. The outcomes for EUS-GBD for acute cholecystitis have been studied, with adverse event rates up to 38.6%, including stent migration, occlusion, infection, and bleeding. Outcomes in patients who are not surgical candidates and undergo EUS-GBD for prevention of biliary complications have not been defined. The objective of this study was to characterize outcomes in this patient population in a retrospective review. Cases were identified using billing data from Massachusetts General Hospital for endoscopic procedures from 2015-2019. Any case that billed for use of a stent for purposes other than EUS-GBD were excluded. Inclusion criteria were patients who underwent EUS-GBD for biliary colic, gallstone pancreatitis, and treatment of gallstones. The indication for GBD and etiology were identified from chart review, with use of the Tokyo criteria to define infectious etiologies. Forty-eight cases of EUS-GBD were identified over the 4-year study period. Twenty were performed for indications aside from acute cholecystitis. These included symptomatic biliary colic, prevention of gallstone pancreatitis, and treatment of gallstones in patients with choledocholithiasis. There was a 100% success rate, with an average admission of 10.9 days. There was a 20% rate of immediate complications, including fever (n=2), persistent abdominal pain (n=1), and bacteremia (n=1); these were all medically managed. Over a one year follow-up period, two patients were re-admitted with gallstone disease; one with symptomatic gallstones and one with pancreatitis. There was a 5% rate of late complications due to bleeding requiring ERCP and re-stenting. There was a stent removal rate of 40% at an average of 47 days post-procedure; these were all planned stent replacements. 25% of patients died within 1 year, with one dying in the same admission, none of which resulted from stent or biliary disease complications. EUS-GBD appears to be a safe and effective way to manage gallstone disease in non-surgical candidates. Overall immediate and delayed complications were low. Recurrent admissions for gallstone related disease were infrequent. Complication rates were similar to those published in patients who underwent EUS-GBD for acute cholecystitis. In conclusion, we suggest that EUS-GBD can be an option for patients who are poor surgical candidates to prevent recurrent gallstone related morbidity.