S184 Is It Beneficial to Dilate the Lumen-Apposing Metal Stent After Placement for EUS-Guided Gallbladder Drainage?

Introduction: Endoscopic ultrasound-guided gallbladder drainage (EUS-GB) using lumen-apposing metal stents (LAMS) has become an important treatment option for patients with cholecystitis who are not surgical candidates. Immediate dilation of the LAMS during the procedure has been suggested to allow for better drainage and improve clinical outcomes. However, potential adverse events such as bleeding or stent migration may occur. There is no current data on the risk and benefit of LAMS immediate dilation. This study aimed to compare the clinical outcomes and adverse events of EUS-GB LAMS with dilation (LAMS-D) and LAMS without dilation (LAMS-ND). Methods: Endoscopic ultrasound-guided gallbladder drainage (EUS-GB) using lumen-apposing metal stents (LAMS) has become an important treatment option for patients with cholecystitis who are not surgical candidates. Immediate dilation of the LAMS during the procedure has been suggested to allow for better drainage and improve clinical outcomes. However, potential adverse events such as bleeding or stent migration may occur. There is no current data on the risk and benefit of LAMS immediate dilation. This study aimed to compare the clinical outcomes and adverse events of EUS-GB LAMS with dilation (LAMS-D) and LAMS without dilation (LAMS-ND). Results: A total of 214 patients were included of which 46.3% were women and the median age was 79.6 years. The LAMS was dilated in 122 (57%) of patients. Technical success was achieved in 100% of the LAMS-D group vs 96.7% for LAMS-ND (P = 0.08). Clinical success was achieved in 98.4% of LAMS-D vs 94.6% in LAMS-ND (P = 0.14). Patients with LAMS-D were more likely to have a 15 mm LAMS compared to LAMS-ND (86.1% vs 59.8%, P < 0.001). There was no significant difference in 30-day post-procedure overall adverse events between the 2 groups (16.4% vs 12.0%, P = 0.36). There was no significant difference in LAMS occlusion (0% vs 1.1%, P = 0.43), LAMS migration (1.6% vs 0%, P = 0.51), bleeding (4.9% vs 2.2%, P = 0.47) or recurrent cholecystitis (4.1% vs 5.4%, P = 0.53) between the 2 groups. Conclusion: Dilation of the LAMS in EUS-GB did not affect adverse events or clinical outcomes. An individualized approach to dilate the LAMS should be based on patient’s clinical presentation and gallbladder characteristics. Additional larger studies are necessary to confirm these findings.