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

• Published in: Gastrointestinal endoscopy Vol. 97; no. 3; pp. 445 - 453
• Main Authors: Robles-Medranda, Carlos, Oleas, Roberto, Puga-Tejada, Miguel, Alcivar-Vasquez, Juan, Del Valle, Raquel, Olmos, Juan, Arevalo-Mora, Martha, Egas-Izquierdo, Maria, Tabacelia, Daniela, Baquerizo-Burgos, Jorge, Pitanga-Lukashok, Hannah
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2023
• Subjects: Cholecystitis, Acute - complications; Cholecystitis, Acute - surgery; Cholestasis - etiology; Cholestasis - prevention & control; Cholestasis - surgery; Cystic Duct; Drainage - adverse effects; Endosonography - adverse effects; Gallbladder - diagnostic imaging; Humans; Neoplasms - complications; Stents - adverse effects; OCD; MBO; EUS-GBD; SEMS
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2022.10.037

Patients with distal malignant biliary obstruction (MBO) and cystic duct orifice tumoral involvement have an increased risk for the development of acute cholecystitis after self-expandable metallic stent (SEMS) placement. We aimed to determine whether primary EUS-guided gallbladder drainage prevents acute cholecystitis in these patients. This was a single-center, randomized control trial in patients with distal MBO enrolled from July 2018 to July 2020. Patients were randomized into 2 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 post-treatment acute cholecystitis, assessed for ≤12 months or until death. The secondary outcomes were hospitalization length and median survival time. Forty-four patients were included in the study: 22 in each group. Five patients in the control group (22.7%) and none in the intervention group experienced acute cholecystitis. The median hospitalization time was significantly lower in the interventional group than in the control group (2 days vs 1 day, P = .017). There was no difference in the observed median survival rates in the primary EUS-GBD group (2.9 months) and the control group (2.8 months) (P = .580). In this single-center study of patients with unresectable MBO and occlusion of the cystic duct orifice, prophylactic EUS-GBD demonstrated a reduced incidence of acute cholecystitis.