P0628 - Single Center Outcome of Endoscopic Ultrasound Gallbladder Drainage in High-Risk Surgical Patients

Sunday, October 24, 2021

3:30 PM – 7:00 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Varun Kesar, MD

Virginia Tech Carilion School of Medicine
Roanoke, VA, United States

Varun Kesar, MD¹, Raj Shah, MD², Vivek Kesar, MD¹, Manoj Kumar, MD¹, Ali Siddiqui, MD³, Paul Yeaton, MD¹
¹Virginia Tech Carilion School of Medicine, Roanoke, VA; ²Carilion Clinic, Roanoke, VA; ³Centura Health, Denver, CO

Introduction: Non-surgical methods to drain gall bladder in high-risk patients who are not surgical candidates includes percutaneous cholecystostomy (PTC) or recently described endoscopic ultrasound guided gall bladder drainage (EGBD). EGBD using lumen apposing metal stents (LAMS) is emerging as a new intervention for the management of acute cholecystitis (figure 1). We performed a retrospective single center study to compare procedural outcomes, clinical outcomes, and adverse events (AE) of EGBD in high-risk non-surgical patient.

Methods: Retrospective chart review was conducted from 1/2014 to 12/2020 to identify patient who underwent EGBD at a tertiary teaching academic center. . EGBD at the center was performed by three interventional endoscopist. Demographic data, clinical success and adverse events was collected.

Results: A total of Sixty-seven patients underwent EGBD. The median age was 76 with calculous cholecystitis as the most common indication for performing procedure. The comorbidities includes cardiovascular disease (69%), Malignancy (36%) and cirrhosis in 12 %. The most common site for axios puncture was duodenum. 10 x15 mm stent was the most used LAMS. The technical success was 98.5 % and clinical success was 92.5. One patient had perforation during procedure, and it was aborted. The procedure related side effects were minimal and includes self-limiting bleeding and gram-negative bacteremia. One patient where PTC was internalized with LAMS using EUS continue to have abdominal pain and there was underwent repeat PTC. The mean follow-up was 8 weeks, however ~50% patients were lost to follow-up.

Discussion: EGBD with LAMS is an effective and safe alternative for the treatment of acute cholecystitis who cannot undergo surgery. Our single center series demonstrated high clinical and technical success and low procedure related adverse events in patient with significant number of comorbidities

Number of EGBD	N= 67
Median age (IQR	76 (68-85)
Race N(%) White Black Hispanic	61 (91.4%) 4 (5.9%) 2 (2.8%)
Sex Female N (%)	32 (47.1%)
Indication n (%) Calculous cholecystitis Acalculous cholecystitis Percutaneous cholecystostomy to EUS gall bladder drainage	52 (77.6 %) 13 (19.5 %) 2 (2.9 %)
Concomitant choledocholithiasis N (%)	29 (43.3 %)
Comorbidities N (%) Cirrhosis Active malignancy Cardiovascular either dchf or CAD	8 (11.9 %) 24 (35.8%) 46 (68.6 %)
Site of axios placement Stomach n (%) Duodenum n (%)	1 (1.5%) 66 (98.5%)
Stent type in mm (LAMS) N (%) 10 x 10 10 x15 10 x20 Not found	5 (7.4%) 57(85.1%) 1 (1.4%) 4 (5.9%)
Technical success N (%)	66 ( 98.5%)
Clinical Success N (%)	62 (92.5 %)
Procedure related adverse events N (%) Bleeding Perforation Infection with bacteremia	3 (4.4%) 1 1 1
Clinical failure	1 perforation 1 EUS TO PTC conversion persistent pain *difficult to assess in 3 more patient as two patient became palliative and another died the following day for another infection
Need for surgery	1 for perforation
Mean Follow-up	7.9 weeks 33 patients were lost to follow-up

Disclosures:

Varun Kesar indicated no relevant financial relationships.

Raj Shah indicated no relevant financial relationships.

Vivek Kesar indicated no relevant financial relationships.

Manoj Kumar indicated no relevant financial relationships.

Ali Siddiqui indicated no relevant financial relationships.

Paul Yeaton indicated no relevant financial relationships.

Varun Kesar, MD¹, Raj Shah, MD², Vivek Kesar, MD¹, Manoj Kumar, MD¹, Ali Siddiqui, MD³, Paul Yeaton, MD¹. P0628 - Single Center Outcome of Endoscopic Ultrasound Gallbladder Drainage in High-Risk Surgical Patients, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.