Su1597 Predictive Factors for Percutaneous Drainage Placement in Patients Developing Bilomas From Bile Leaks

Abstract

Su1596 A Suggested Method for Preventing Post Palliative SEMS Cholecystitis in Selective Patients With Courvoisier’s Gallbladder, a Preliminary Study Tariq A. Hammad*, Yaseen Alastal, Muhammad Ali Khan, Usman Ahmad, Muhammad Z. Bawany, Osama Alaradi, Ali Nawras Internal Medicine Division of Gastroenterology and Hepatology, University of Toledo, Toledo, OH Background: Cholecystitis is a potential complication for self-expandable Metallic stents (SEMS) that occurs in about 2-12% of patients. Objective: This study suggests a method to minimize the risk of post palliative SEMS cholecystitis in very high risk group of patients. This method has been adapted at our institution after having few incidences on post SEMS cholecystitis requiring interventional treatment.Design: Single arm study and single center design.Setting: University tertiary medical center. Patients: Five consecutive patients with obstructive jaundice and Courvoisier’s gallbladder (GB) secondary to suspected malignant pancreatic-biliary tumor.Intervention: Endoscopic ultrasound guided decompression of the Courvoisier GB by fine needle aspiration. Patients underwent a single session of EUS-FNA for diagnosis and staging of the tumors, and ERCP for possible palliative SEMS. Once the patients were assigned to palliative SEMS based on the clinical, radiographic and cytopathologic findings (table 1); the need for GB decompression was carefully assessed based on several factors (Diagram). Patients with Courvoisier GB whom CD’s were not visualized during the ERCP underwent this procedure. Results: All patients had the procedure without complications. None of the patients developed any clinical symptoms or signs of post SEMS cholecystitis. Conclusion: Endosonographic guided Courvoisier GB decompression post simultaneous palliative SEMS placement and diagnostic EUS -FNA is a suggestive method for preventing cholecystitis. Larger studies are required to validate these results. Patients’ Characteristics.