1. Endoscopic ultrasound-guided gallbladder drainage as a rescue therapy for unresectable malignant biliary obstruction: a multicenter experience
- Author
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Srihari Mahadev, Danny Issa, Kartik Sampath, David L. Carr-Locke, Mouen A. Khashab, Kaveh Hajifathalian, Ryan Law, Shayan Irani, Sean Bhalla, Saurabh Mukewar, Shawn L. Shah, and Reem Z. Sharaiha
- Subjects
Endoscopic ultrasound ,medicine.medical_specialty ,medicine.medical_treatment ,Duodenal stenosis ,Endosonography ,Medicine ,Humans ,Ultrasonography, Interventional ,Retrospective Studies ,Cholangiopancreatography, Endoscopic Retrograde ,Endoscopic retrograde cholangiopancreatography ,Cholestasis ,medicine.diagnostic_test ,business.industry ,Bile duct ,Gallbladder ,Gastroenterology ,Stent ,Retrospective cohort study ,medicine.disease ,digestive system diseases ,Surgery ,medicine.anatomical_structure ,Cholecystitis ,Drainage ,Stents ,business - Abstract
Background Endoscopic retrograde cholangiopancreatography (ERCP) is often unsuccessful in patients with duodenal stenosis or malignant ampullary infiltration. While endoscopic ultrasound-guided biliary drainage (EUS-BD) has been proposed as an alternative, EUS-guided gallbladder drainage (EUS-GBD) is an attractive option when both approaches fail. We aimed to assess the effectiveness and safety of EUS-GBD as rescue therapy for malignant distal bile duct obstruction. Methods A multicenter retrospective study was performed on patients with unresectable malignant distal bile duct obstruction who underwent EUS-GBD between 2014 and 2019 after unsuccessful ERCP and EUS-BD. Clinical success was defined as a decrease in serum bilirubin of > 50 % within 2 weeks. Results 28 patients were included, with a lumen-apposing metal stent used in 26 (93 %) and a self-expandable metal stent in two (7 %). The technical success rate was 100 %. The clinical success rate was 93 %, with an improvement in bilirubin (7.3 [SD 5.4] pre-procedure vs. 2.8 [SD 1.1] post-procedure; P = 0.001). Delayed adverse events included food impaction of the stent (n = 3), with a further two patients developing cholecystitis and bleeding. Conclusion This study demonstrates the feasibility of gallbladder drainage to relieve malignant distal bile duct obstruction in patients with failed ERCP and EUS-BD.
- Published
- 2020