B0442 - Safety and Efficacy of Endoscopic Ultrasound-Guided Gallbladder Drainage Performed by Early Career Advanced Endoscopists: A Multicenter Experience

Monday, October 24, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Nicholas McDonald, MD

University of Minnesota
Minneapolis, MN

Nicholas McDonald, MD¹, Amir Rumman, MD², Maham Hayat, MD², Natalie Wilson, MD¹, Arjun Sondhi, MD³, Munish Ashat, MD⁴, Amaninder Dhaliwal, MD⁵, Rahman Nakshabendi, MD⁶, Mohamed Abdallah, MD⁷, Corey Miller, MD⁸, Mohammad Bilal, MD⁹
¹University of Minnesota, Minneapolis, MN; ²University of Oklahoma Health Sciences Center, Oklahoma City, OK; ³Iowa Digestive Disease Center, Clive, IA; ⁴University of Iowa Hospitals and Clinics, Iowa City, IA; ⁵McLeod Digestive Health Center, Florence, SC; ⁶Florida Advanced Gastroenterology Center, Brandon, FL; ⁷University of Minnesota Medical Center, Minneapolis, MN; ⁸McGill University, Montreal, PQ, Canada; ⁹University of Minnesota, Minneapolis VA Medical Center, Minneapolis, MN

Introduction: Endoscopic ultrasound-guided gallbladder drainage (EGBD) using lumen-apposing metal stents (LAMS) has increasingly become an option for patients with acute cholecystitis or symptomatic cholelithiasis who are not surgical candidates. Recent studies have shown EGBD to be safe and effective. However, these data come from experienced advanced endoscopists. There is currently no data regarding the safety and effectiveness of EGBD in the hands of early career advanced endoscopists. We aimed to evaluate the safety and effectiveness of EGBD performed by early career advanced endoscopists.

Methods: This was a multicenter, retrospective analysis of all patients who underwent EGBD, performed by 7 early career advanced endoscopists. Early career advanced endoscopist was defined as within two years of graduating advanced endoscopy fellowship. Patient and procedural characteristics were recorded. Primary outcomes were technical and clinical success. Technical success was defined as the ability to place the stent within the gallbladder. Clinical success was defined as improvement or resolution of gallbladder related symptoms within 5 days of the procedure. Other outcomes included adverse events and procedure related mortality.

Results: A total of 21 patients underwent EGBD. All advanced endoscopists were within 18 months of completion of an American Society for Gastrointestinal Endoscopy (ASGE) accredited advanced endoscopy fellowship. The indication was acute cholecystitis in 18 cases (86%) and symptomatic cholelithiasis in 3 cases (14%). 48% were female, 81% were inpatients and the mean age was 75 years. The mean platelets and INR were 247 K/cmm and was 1.2, respectively. Eight patients were on anticoagulation. The EGBD was performed with the transgastric approach in 15 cases (71%) and transduodenal approach in 6 cases (29%). Clinical and technical success were achieved in all cases. One patient developed post-procedural pain within 30 days and one patient required overnight admission overnight. No patients developed recurrent cholecystitis, bleeding, perforation, stent migration or death within 30 days. Ten patients (48%) had the LAMS removed and the average time to LAMS removal was 41 days. The median duration of follow-up was 75 days.

Discussion: Our findings suggest that endoscopic ultrasound-guided gallbladder drainage is safe and effective in the hands of formally trained early career advanced endoscopists.

Indication	N = 21 patients
Acute Cholecystitis	18 (86%)
Symptomatic Cholelithiasis	3 (14%)
Patient characteristics
Female	10 (48%)
Age	75 years (SD 12)
Inpatient	17 (81%)
Chronic kidney disease	3 (14%)
Diabetes mellitus	11 (52%)
Cirrhosis	1 (5%)
Platelet count (K/cmm)	247 (SD 64)
INR	1.2 (SD 0.22)
Anticoagulation use Apixaban Enoxaparin	8 (38%) 7 (33%) 1 (5%)
Procedure characteristics
Site of Lumen Apposing Metal Stent placement Stomach Duodenum	15 (71%) 6 (29%)
Size of Lumen Apposing Metal Stent 10 mm x 10 mm 15 mm x 10 mm	14 (67%) 7 (33%)
Outcomes
Technical success	21 (100%)
Clinical success	21 (100%)
Stent removed	10 (48%; average 41 days)
Recurrent Cholecystitis	0
Length of follow-up (days, median)	75
Adverse events
Any adverse event	2 (10%)
Need for admission following procedure	1 (5%)
Post-procedural pain within 30-days	1 (5%)
Death within 30-days	0

Table: Table 1. Patient and Procedural Characteristics.

Disclosures:

Nicholas McDonald indicated no relevant financial relationships.

Amir Rumman indicated no relevant financial relationships.

Maham Hayat indicated no relevant financial relationships.

Natalie Wilson indicated no relevant financial relationships.

Arjun Sondhi indicated no relevant financial relationships.

Munish Ashat indicated no relevant financial relationships.

Amaninder Dhaliwal indicated no relevant financial relationships.

Rahman Nakshabendi indicated no relevant financial relationships.

Mohamed Abdallah indicated no relevant financial relationships.

Corey Miller indicated no relevant financial relationships.

Mohammad Bilal indicated no relevant financial relationships.

Nicholas McDonald, MD¹, Amir Rumman, MD², Maham Hayat, MD², Natalie Wilson, MD¹, Arjun Sondhi, MD³, Munish Ashat, MD⁴, Amaninder Dhaliwal, MD⁵, Rahman Nakshabendi, MD⁶, Mohamed Abdallah, MD⁷, Corey Miller, MD⁸, Mohammad Bilal, MD⁹. B0442 - Safety and Efficacy of Endoscopic Ultrasound-Guided Gallbladder Drainage Performed by Early Career Advanced Endoscopists: A Multicenter Experience, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.