Safety and efficacy of endoscopic ultrasound-guided gallbladder drainage combined with endoscopic retrograde cholangiopancreatography in the same session

Dig Endosc. 2020 May;32(4):608-615. doi: 10.1111/den.13562. Epub 2019 Nov 22.

Abstract

Background and aim: Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is an emerging option for acute cholecystitis in non-surgical candidates. Combining endoscopic retrograde cholangiopancreatography (ERCP) for common bile duct stones with EUS-GBD in a single session might become a non-surgical management strategy to comprehensively treat gallstone disease in selected patients.

Methods: Single-center retrospective cohort study comparing outcomes between EUS-GBD alone (group A) and single-session ERCP combined with EUS-GBD (group B). Consecutive patients who underwent EUS-GBD with a lumen-apposing metal stent (LAMS) between June 2011 and August 2018 were analyzed. Exclusion criteria were subjects included in randomized clinical trials, patients who had had ERCP within 5 days of EUS-GBD, patients in whom ERCP or EUS-GBD was carried out for salvage of one or the other procedure, and patients who underwent concurrent EUS-guided biliary drainage.

Results: One hundred and nine consecutive patients underwent EUS-GBD with LAMS during the study period. Seventy-one patients satisfied the inclusion criteria and 34 patients were in group A and 37 in group B. Baseline characteristics were similar in both groups. There were no significant differences in technical (97.1% vs 97.3%; P = 0.19) and clinical success rates (88.2% vs 94.6%; P = 0.42) of EUS-GBD in group A versus group B. Rate of adverse events was similar in both groups, five (14.7%) in group A versus five (13.5%) in group B.

Conclusions: Single-session EUS-GBD combined with ERCP has comparable rates of technical and clinical success to EUS-GBD alone. A combined EUS-GBD and ERCP procedure does not appear to increase adverse events and makes possible comprehensive treatment of gallstone disease by purely endoscopic means.

Keywords: acute cholecystitis; endoscopic retrograde cholangiopancreatography; endoscopic ultrasound; gallstone; retrospective studies.

MeSH terms

  • Aged, 80 and over
  • Cholangiopancreatography, Endoscopic Retrograde*
  • Cholecystitis, Acute / complications
  • Cholecystitis, Acute / diagnosis
  • Cholecystitis, Acute / surgery*
  • Drainage*
  • Endosonography*
  • Female
  • Gallstones / complications
  • Gallstones / diagnosis
  • Gallstones / surgery*
  • Humans
  • Male
  • Retrospective Studies
  • Treatment Outcome