S2292 EUS-GBD for Salvage of Gallbladder Drainage in Non-Surgical Candidates With Inability to Remove Percutaneous Drains: A Multi-Centered Retrospective Analysis

Introduction: Acute cholecystitis (AC) is a common disease with rising incidence owing to increased obesity-related disease. Historically, AC is treated with cholecystectomy, but a subset of patients is deemed inappropriate for cholecystectomy and are managed acutely with percutaneous gallbladder drainage (PGBD), often performed by Interventional Radiology. EUS-Gallbladder drainage (EUS-GBD) is an endoscopic technique typically used in the treatment of cholecystitis in patients who are not appropriate for surgery. EUS-GBD has been used in patients with PGBD in whom drain removal is not feasible, but published data is lacking. Methods: We retrospectively analyzed patients referred for salvage EUS-GBD to understand the technical feasibility and outcomes related to EUS-GBD with intent to establish and preserve internalized gallbladder drainage and, ultimately, removal of the percutaneous drain. Results: There were 10 patients in whom EUS-GBD was planned for PGBD reversal. All 10 patients had pain at the drain site; 70% had leak from the drain; 70% had recurrent cholecystitis from drain occlusion; 30% had inadvertently removed the drain, requiring replacement. Two previously had drains removed; however, both of these patients had recurrence of cholecystitis within 6 months of drain removal and subsequent drain replacement. The average number of drain exchanges per patient was 2.7 ± 2.4. Two patients had undergone a mean of 2 percutaneous endoscopic biliary lithotomy (PEBL) procedures, without success. Technical success (defined by successful drainage of the gallbladder) was achieved in 80%, 50% being transantral, and 50% transduodenal. Among the remaining 2 patients, one had intervening cancer, and the other had significant varices/cavernoma, preventing safe windows for endoscopic drainage. There were no adverse events seen in this cohort, and all patients in whom EUS-GBD was performed had successful removal of their percutaneous drains. One patient died within 30 days of EUS-GBD due to progression of malignancy. An additional 5 patients died within 2 to 22 months, 2 of which were those with aborted EUS-GBD (both with metastatic cancer); 2 others with metastatic cancer; one with severe infected pancreatic necrosis; and one with severe cardiac disease. Conclusion: EUS-GBD is a feasible, effective, and safe technique for internalization of gallbladder drainage in patients with percutaneous cholecystostomy tubes. This technique allows for subsequent successful removal of the percutaneous drain.