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Prophylactic EUS-guided gallbladder drainage prevents acute cholecystitis in patients with malignant biliary obstruction and cystic duct orifice involvement: A randomized trial (with video)

Open AccessPublished:October 31, 2022DOI:https://doi.org/10.1016/j.gie.2022.10.037
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      Abstract

      Background and aims

      Patients with distal malignant biliary obstruction (MBO) and cystic duct orifice tumoral involvement have an increased risk of developing acute cholecystitis following self-expandable metallic stent (SEMS) placement. We aimed to determine whether primary endoscopic ultrasound (EUS)-guided gallbladder drainage prevents the occurrence of acute cholecystitis in these patients.

      Methods

      This was a single-center, randomized control trial in patients with distal MBO enrolled from July 2018 to July 2020. Patients were randomized into two groups: an interventional group, treated with conventional ERCP biliary drainage with SEMS placement and subsequent primary EUS-guided gallbladder drainage (EUS-GBD), and a control group, treated with conventional biliary drainage alone. The primary outcome of the study was the occurrence of posttreatment acute cholecystitis, assessed for up to 12 months or until death. The secondary outcomes were the hospitalization length and median survival time.

      Results

      Forty-four patients were included in the study: 22 in each group. Five in the control group (22.7%) and none in the intervention group developed acute cholecystitis. The median hospitalization time was significantly lower in the interventional group than in the control group (2 days vs. 1 day, P=0.017). There was no difference in the observed survival rates median for the primary EUS-guided gallbladder drainage group (2.9 months) and control group (2.8 months) (P=0.580).

      Conclusion

      In this single center study of patients with unresectable MBO and occlusion of the cystic duct orifice, prophylactic EUS-guided gallbladder drainage demonstrated a reduced incidence of acute cholecystitis.

      Keywords

      Acronyms and abbreviations:

      SEMS (Self-expandable metal stent), OCD (Orifice of the cystic duct), MBO (Malignant biliary obstruction), TPGBM (Transpapillary gallbladder drainage), EUS (Endoscopic ultrasound), EUS-GBD (Endoscopic ultrasound-guided gallbladder drainage), CE (Contrast enhanced), MRCP (Magnetic resonance cholangiopancreatography), ERCP (Endoscopic retrograde cholangiopancreatography), LAMS (Lumen-apposing metallic stent)