S2290 Endoscopic Ultrasound Gallbladder Drainage for Cholecystectomy in the Non-Surgical Candidate: A Multicentered Experience

Introduction: Endoscopic Ultrasound gallbladder drainage (EUS-GBD) is a well-validated tool in the armamentarium for treatment of patients with cholecystitis, particularly those who are not candidate for surgical intervention. Methods: After implementation of a multi-disciplinary system protocol for management of patients with acute cholecystitis, we sought to retrospectively investigate prospectively collected data on outcomes related to EUS-GBD at our 5-hospital system. Results: Among 64 patients who were referred for EUS-GBD, 61 patients (technical success of 95.3%) successfully underwent EUS-GBD. Mean age of patients was 73.3 ± 14.6. Thirty (46.9%) were woman. Mean American Society of Anesthesiology (ASA) Score was 3.6 ± 0.7; mean Eastern Cooperative Oncology Group (ECOG) Performance Status of 2.3 ± 1.1; and mean Charlson Comorbidity Index (CCI) was 7.8 ± 3.1. Common indications for non-surgical candidacy included: malignancy (42.2% with 29.7% of all patients having metastatic malignancy), advanced cardiopulmonary disease (34.4%), severe malnutrition (31.3%), advanced dementia (28.1%), chronic deconditioning and poor performance status (23.4%), severe acute illness (21.9%; septic shock in 10.9%; multisystem organ failure in 10.9%; acute decompensated heart failure in 6.3%; infected walled off necrosis in 4.7%; acute respiratory failure in 3.1%; cardiogenic shock in 3.1%; and coma in 1.1%), failure of previous percutaneous drainage (15.6%), and advanced age (10.9%). All EUS-GBD were performed using lumen-apposing metal stents (LAMS) with 19 (31.1%) placed transantrally, and 42 (69.9%) placed transduodenally. Three procedure (4.7%) were aborted, 2 of which for tumor or varices intervening the drainage window and one for bradycardia induced by anesthesia; in none of these cases was LAMS placement attempted. Adverse events occurred in 10 patients (16.4%) and included post-procedure abdominal pain (14.8%), LAMS misdeployment (3.1%), and delayed LAMS migration with perforation (1.6%). Other adverse events not attributable to the LAMS/EUS-GBD included GI hemorrhage in 3 patients (4.9%). There were no unplanned readmissions; one unplanned procedure for retrieval of a migrated LAMS, EUS-GBD with double pigtailed plastic stenting, and closure of the duodenal defect (1.6%); and 5 patients (8.2%) died within 30 days of EUS-GBD due to other illness. Conclusion: EUS-GBD is feasible and safe in the non-surgical cholecystitis cohort, even in patients with advanced acute and chronic illness.