S2296 EUS-Gallbladder Drainage for Cholecystitis: Is LAMS Removal and Replacement With Permanent Indwelling Stents Associated With Difference in Outcomes? A Multi-Centered Experience

Introduction: Endoscopic Ultrasound gallbladder drainage (EUS-GBD) is now used in the management of cholecystitis in non-surgical candidates for cholecystectomy. Typically, transluminal drainage is performed by using a lumen-apposing metal stent (LAMS). In early cases, the LAMS would not be removed. However, it is now common for the LAMS to be removed endoscopically after maturation of the fistula to the gallbladder with subsequent placement of permanent indwelling plastic stents for indefinite gallbladder drainage and prevent recurrent cholecystitis. Methods: A retrospective analysis of prospectively collected data was used to compared outcomes with AXIOS retention as compared to removal and replacement with permanent indwelling plastic stenting. Results: Sixty-one EUS-GBD cases were performed in our 5-hospital system. No recurrent cholecystitis or stent occlusion was seen within 30 days. One patient had migrated LAMS with resulting pneumoperitoneum within 24 hours of placement and was managed endoscopically with LAMS removal, salvage cholecystoduodenostomy using plastic double pigtailed stent, and defect closure with clips; as such, this patient was excluded from the study. Additionally, 2 patients were lost to follow up, and 5 patients did not reach at least 30 days of follow up or death and were, thus, not included. Of the remaining 53 patients, 21 had the LAMS removed (mean duration to LAMS removal was 1.1 ± 0.3 months) with average of 2.1 ± 0.5 plastic double pigtailed stents placed. Comparing the 2 groups, baseline demographics that did not differ included, American Society of Anesthesiology (ASA), Eastern Cooperative Oncology Group (ECOG) Performance Status, and whether malignancy was present as the main indication for EUS-GBD; however, the subgroup in which the LAMS was not removed had higher a higher mean Charlson Comorbidity (CCI) Score (7.0 ± 3.3 vs 8.5 ± 2.8, P = 0.044) and higher mean Tokyo Consensus 2018 Cholecystitis Severity Score (1.8 ± 0.7 vs 2.4 ± 0.6, P = 0.005). There were no statistically significant differences in adverse events, 30-day mortality, or 90-day mortality. There was no delayed, LAMS-related hemorrhage seen in either group. There were no stent occlusions, and no recurrent cholecystitis was seen in either group. Conclusion: While further studies with longer follow up are needed to more reliably answer whether LAMS removal is the better strategy, our study shows equivalent outcomes whether LAMS is removed or retained.