Elsevier

Gastrointestinal Endoscopy

Volume 85, Issue 2, February 2017, Pages 357-364
Gastrointestinal Endoscopy

Original article
Clinical endoscopy
Percutaneous transhepatic versus EUS-guided gallbladder drainage for malignant cystic duct obstruction

https://doi.org/10.1016/j.gie.2016.07.067Get rights and content

Background and Aims

Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has been proposed as an alternative management strategy for acute cholecystitis caused by malignant cystic duct obstruction in patients for whom surgery is not an option. This study aimed to compare the results of EUS-GBD with those of percutaneous transhepatic gallbladder drainage (PTGBD) for palliative management of malignant cystic duct obstruction with acute cholecystitis or symptomatic gallbladder hydrops.

Methods

Between November 2013 and November 2015, 14 patients with acute cholecystitis or symptomatic gallbladder hydrops as a result of malignant cystic duct obstruction underwent EUS-GBD with covered metal stents. Nineteen patients with acute cholecystitis as a result of malignant cystic duct obstruction who received PTGBD served as a control group. Patients’ medical records were reviewed retrospectively.

Results

The technical and clinical success rates of EUS-GBD were 85.7% (12/14) and 91.7% (11/12) and of PTGBD were 100% (19/19) and 86.4% (17/19), respectively. The groups had similar adverse event rates (28.5% and 21.1%, respectively). The average duration of stent patency in patients with EUS-GBD was 130.3 ± 35.3 days, and no patient required an additional procedure before death. In 6 of 17 patients (35.3%) with clinically successful PTGBD, the catheter was not removed until the end stage of life.

Conclusions

EUS-GBD is a feasible, safe, and effective modality for the treatment of malignant cystic duct obstruction in patients who are not indicated for surgery. It enables improved long-term quality of life in patients with advanced-stage cancer.

Section snippets

Patients

Between January 2013 and November 2015, 14 patients with acute cholecystitis or symptomatic gallbladder hydrops as a result of malignant cystic duct obstruction underwent EUS-guided transgastric or transduodenal drainage with a covered metal stent. Patient data were collected via retrospective chart review. A prospectively collected EUS database at Seoul National University Bundang Hospital was reviewed retrospectively to identify consecutive patients.

As a control group, 19 patients with acute

Baseline characteristics

The baseline characteristics of the 14 patients who underwent EUS-GBD and 19 patients who underwent PTGBD during the study period are shown in Table 1. In the EUS-GBD group, the underlying malignancy diagnoses were intrahepatic cholangiocarcinoma (n = 2, 14.3%), common bile duct cancer (n = 3, 21.4%), Klatskin tumor (n = 4, 28.6%), and gallbladder cancer (n = 5, 35.7%). The reasons for EUS-GBD were malignant cystic duct obstruction including acute cholecystitis (n = 11, 78.6%) and painful

Discussion

Malignant cystic duct obstruction is an uncommon adverse event in patients with hepatobiliary malignancy. PTGBD is traditionally considered the treatment of choice for the palliative management of this adverse event, because patients are usually not candidates for cholecystectomy. However, removal of the PTGBD catheter is sometimes difficult, which worsens the quality of life of these patients. In this regard, long-term endoscopic internal drainage is a more attractive option than external

References (34)

Cited by (54)

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  • Trial sequential analysis of EUS-guided gallbladder drainage versus percutaneous cholecystostomy in patients with acute cholecystitis

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    Finally, 9 studies met the inclusion criteria after assessment of the full articles and were considered for data extraction. Of those 9, 3 studies reporting outcomes after drainage with stents other than LAMSs9-11 and 1 study that reported mixed results from transpapillary and transmural EUS-GBD12 were excluded. Additionally, another study from 201613 was subsequently updated and enlarged in 2019,14 and the latter was retained for the analyses.

  • Comparison of EUS-guided endoscopic transpapillary and percutaneous gallbladder drainage for acute cholecystitis: a systematic review with network meta-analysis

    2021, Gastrointestinal Endoscopy
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    Table 1 depicts assessment of bias. Of the retrospective studies, all 8 were considered very low quality, with studies lacking randomization and allocation concealment.3,14-20 For the 2 randomized controlled trials, the level of evidence was considered moderate to low.12,13

  • EUS-guided gallbladder drainage versus laparoscopic cholecystectomy for acute cholecystitis: a propensity score analysis with 1-year follow-up data

    2021, Gastrointestinal Endoscopy
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    This suggests that EUS-GBD may reduce the risk of gallstone-related adverse events, and this may be a potential option in the group of patients who do not want to undergo cholecystectomy. EUS-GBD is gaining popularity as an option of draining the gallbladder in patients at very high risk of cholecystectomy.1-17 In a recently completed randomized controlled trial of EUS-GBD and percutaneous cholecystostomy, EUS-GBD was associated with reduced 1-year adverse events (25.6% vs 77.5%, P < .001), 30-day adverse events (12.8% vs 47.5%, P = .010), reinterventions after 30 days (2.6% vs 30%, P = .001), number of unplanned readmissions (15.4% vs 50%, P = .002), and recurrent cholecystitis (2.6% vs 20%, P = .029).

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DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.

If you would like to chat with an author of this article, you may contact Dr Kim at [email protected].

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