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EUS-GUIDED GALL BLADDER DRAINAGE WITH ELECTROCAUTERY-ENHANCED LUMEN-APPOSING METAL STENTS: A UK AND IRELAND MULTI-CENTRE COLLABORATION

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Introduction

EUS-guided gall bladder drainage (EUS-GBD) with an electrocautery-enhanced lumen-apposing metal stent (EC-LAMS) is emerging as a method of establishing gall bladder drainage in patients who lack fitness for surgery¹.
The aim of the study was to assess the efficacy, safety and long-term outcomes in patients who underwent EUS-GBD with an EC-LAMS.

Aims & Methods

A retrospective review of consecutive patients who underwent EUS-GBD with EC-LAMS at 11 tertiary institutions across the United Kingdom and Ireland between January 2016 and December 2022 was undertaken.

Results

Sixty two patients (71.0% female; n=44) with a median age of 74.6 years (range 33-95 years) were included. The predominant approach was transduodenal (59.7%; n=37), while the most common indication was non-malignant cholecystitis (56.5%; n=35).
The mean follow-up period was 2.1 years (range 0.04-6.9 years); 72.6% (n=45) were alive at the end of the follow-up period.
Technical success, defined as successful gall bladder access followed by adequate transmural EC-LAMS deployment, was achieved in 95.2% (n=59). Clinical success, defined as resolution of clinical parameters of acute cholecystitis (as per Tokyo 2018 diagnostic criteria) within 96 hours was achieved in 94.7% (n=54).
The 30-day adverse event rate was 4.8% (n=3), with 3.2% (n=2) experiencing a severe/fatal event (as per ASGE lexicon). A further adverse event (1 severe) occurred in 14.8% (n=4) of those who were followed up for a year and in 7.1% (n=1) of those who were followed up for two years.
Of those with benign disease, the EC-LAMS was removed in 15.0% (n=3) of cases who were followed up for at least one year. This was associated with an adverse event (recurrent cholecystitis) in only one case.

Conclusion

EUS-GBD with EC-LAMS at tertiary institutions is a highly effective and relatively safe technique in patients who are not fit for surgery. Technical failures or adverse events can usually be managed conservatively or with endoscopic therapy.