Su1385 EUS-GUIDED GALLBLADDER DRAINAGE FOR ACUTE CHOLECYSTITIS AFTER METAL STENT PLACEMENT FOR UNRESECTABLE MALIGNANT BILIARY STRICTURE

Abstract

It is often difficult to treat acute cholecystitis after metal stent (MS) placement for unresectable malignant biliary stricture. We aimed to evaluate a case series of EUS-GBD, which have been recently reported to be useful, percutaneous transhepatic gallbladder drainage (PTGBD), and percutaneous transhepatic gallbladder aspiration (PTGBA) for such condition. Twenty-seven patients who underwent intervention, i.e., EUS-GBD, PTGBD, or PTGBA, for acute cholecystitis after MS placement in the bile duct at our center from January 2011 to October 2017 were included in this study. The technical success, clinical usefulness, procedure-related adverse events, and recurrence of acute cholecystitis were retrospectively evaluated. Eight EUS-GBD procedures, 10 PTGBD procedures, and 17 PTGBA procedures were performed with an overlap. All procedures were technically successful. The clinical usefulness was obtained in 86% (7/8) of the EUS-GBD group, 90% (9/10) of the PTGBD group, and 65% (11/17) of the PTGBA group. Several adverse events were observed after EUS-GBD (50%, 4/8: 1, severe bile leakage; 3, mild bile peritonitis), PTGBD (10%, 1/10: suspicious transthoracic tube placement), and PTGBA (0%). In 1 patient who had undergone EUS-GBD for severe necrotized cholecystitis, emergency cholecystectomy was performed due to severe bile leakage. Acute cholecystitis recurred in 3 patients of the EUS-GBD group (43%, 3/7), 1 patient of the PTGBD group (11%, 1/9) and 2 patients of the PTGBA group (18%, 2/11) after the median interval period of 27 days during the mean follow-up period of 114 days. The mean overall survival period after EUS-GBD, PTGBD, and PTGBA was 132, 100, and 111 days, respectively. EUS-GBD was found to be feasible for acute cholecystitis after MS placement into the bile duct. However, because of high adverse event rate, percutaneous intervention would be appropriate as the first step. Further technical establishment and development of devices dedicated for EUS-GBD are desired.