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IS THE ANESTHESIOLOGIST STILL NEEDED FOR ENDOSCOPIC ULTRASOUND-GUIDED GALLBLADDER DRAINAGE?

Anna Cominardi 1, Giuseppe Comparato 1, Cattaneo Gaetano 1, Giovanni Aragona 1

Affiliations

1 Ospedale Guglielmo da Saliceto di Piacenza, Piacenza, Italy

Summary

AI Generated

Endoscopic ultrasound-guided gallbladder drainage under conscious sedation achieved 97.9% technical and clinical success with only 2% early adverse events in 49 high-risk patients.

The study prospectively enrolled 49 consecutive patients (mean age 82.9 years) undergoing EUS-GBD under conscious sedation from January 2020 to December 2022, with 95.9% treated for acute cholecystitis in high-surgical-risk patients
Technical and clinical success rates were both 97.9%, with one procedure failing due to LAMS malfunction and one failing to reduce inflammatory indices
Only one early adverse event (2%) was reported and no late adverse events occurred
Three sedation regimens were compared: pethidine plus benzodiazepine (59.2%), fentanyl plus benzodiazepine (36.7%), and benzodiazepine alone (4.1%), with no statistically significant differences in technical success, clinical success, or adverse event rates among groups
This material is most relevant for interventional endoscopists managing high-risk patients who may not tolerate deep sedation for gallbladder drainage procedures

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Endoscopic ultrasound-guided gallbladder drainage is usually reserved for high surgical risk patients. The procedure was usually performed under deep sedation to ensure the best tolerability for the patient and facilitate the endoscopist’s performance.
However, many of them showed a high-risk even for deep sedation.

Aims & Methods

Our aim was to evaluate the safety and efficacy of EUS-GBD under conscious sedation (CS).
All consecutive EUS-GBD under CS performed in our hospital were prospectively enrolled from January 2020 to December 2022.
Patient characteristics, type and dosage of anesthetic drug administered (Fentanyl (FNT), Pethidine (PTD) or Benzodiazepine (BZD)), size of lumen-apposing-metal-stent (LAMS), gallbladder (GB) access, technical success, clinical success, early and late adverse events (AEs) rate were evaluated. Safety was defined as AEs occurrence. The efficacy of EUS-GBD was expressed as technical and clinical success. We defined as “conscious sedation” a drug-induced depression of consciousness during which patients respond to verbal commands or react to touch. Breathing remains intact and no support is needed.

Results

A total of 49 patients (41.7% male, mean age 82,9±10 years-old) underwent EUS-GBD under in our Unit. Among all the 49 EUS-GBD in CS, 47 (95.9%) were indicated as treatment for acute cholecystitis in high-surgical-risk patients and 2 (4.1%) as rescue-strategy after ERCP fail.
In 45 (91.8%) EUS-GBD a 10x10mm LAMS was deployed, in 3 (6.2%) procedures a 15x10mm and in 1 (2%) an 8x8mm LAMS. GB was accessed from the duodenum in 68.8% of cases.
A combination of PTD+BZD was administered in 29 (59.2%) EUS-GBD, while 18 (36.7%) procedures were performed under FNT+BZD. Only 2 (4.1%) EUS-GBD were performed only under BZD.
Mean FNT, PTD, BZD dose were 50(±11.5) mcg, 38.4(±25.6) mg and 4(±1.5) mg, respectively.
Technical success of EUS-GBD under CS was 97.9%. In one procedure the distal flange of the LAMS did not open due to LAMS malfunction. The clinical success of EUS-GBD under CS was 97.9% since in one procedure there was not a decrease of inflammatory, cytolysis and cholestasis indices. Only in 1 (2%) EUS-GBD an early AE was reported. No late AEs were described.
The statistical analysis showed that the administration of a combination of fentanyl and benzodiazepine or a combination of pethidine and benzodiazepines or the administration of only benzodiazepines affected neither technical nor clinical success, nor AEs rate (Table 1).

	PTD+BZD	FNT+BZD	BZD
Technical success	p=0.4014	p=0.4413	p=0.8349
Clinical success	p=0.3930	p=0.4337	p=0.8331
Adverse events	p= 0.2237	p=0.1846	p=0.8349

Conclusion

EUS-GBD under CS was a safe procedure with a low AEs rate.
The administration of FNT+BZD, PTD+BZD or BZD alone did not affect procedure outcome.

Conference

UEG Week Copenhagen 2023

Topics

Hepatobiliary

Submission format

Abstract

Session

PP 07 Liver & biliary (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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NOVEL BIOLOGICAL AND RADIOLOGICAL MARKERS FOR PREDICTING MALIGNANT PROGRESSION IN INTRADUCTAL PAPILLARY MUCINOUS NEOPLAMS: A PROSPECTIVE STUDY

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