S2291 Comparison of Transantral and Transduodenal Approaches for EUS-Gallbladder Drainage: A Multi-Centered Experience

Introduction: EUS-Gallbladder Drainage (EUS-GBD) is an excellent modality by which to internalize gallbladder drainage in patients with cholecystitis, particularly in those who are deemed non-surgical candidates. Two approaches for drainage are typically performed, transantral (TA) and transduodenal (TD) with some studies suggesting no difference between the 2 routes of internalized gallbladder drainage. Methods: We retrospectively reviewed prospectively collected data and outcomes for EUS-GBD specifically to understand differences between TA and TD approaches with regard to outcomes and adverse events. Results: Sixty-one EUS-GBD procedures were successfully performed in our 5-hospital system. Baseline demographic data was similar in both groups with regard to age, gender, race, American Society of Anesthesiology (ASA) Score, Charlson Comorbidity Index (CCI) Score, Tokyo Consensus 2018 Cholecystitis Severity Score, or whether procedure was performed as outpatient or inpatient. Eastern Cooperative Oncology Group (ECOG) Performance Status did differ with higher ECOG (lower performance status) noted in the TA group (2.6 ± 0.9 vs 2.1 ± 1.2, P = 0.047). Technical success was 100% in the TA group vs 97.6% in the TD group. TA vs TD sampling did not affect microbial isolation in cultures obtained from gallbladder aspirates, nor did either approach result in differences in reliable, non-contaminated specimens (P = 0.7). Overall adverse events were similar between both groups (15.8% in TA group vs 16.7% in TD group, P = 0.9) with transient, post-procedural pain being the most reported adverse event (15.8% of all TA patients vs 14.2% of all TD patients, 14.8% overall). One LAMS misdeployment occurred with a TD patient requiring conversion to TA drainage, and one patient in the TD group required an unplanned, emergent endoscopic intervention for delayed LAMS migration resulting in perforation, which was treated with removal of the LAMS, EUS-GBD with double pigtailed stenting, and endoscopic clip closure of the duodenal defect. There were no adverse events beyond 24 hours post-procedure. There were no recurrent cholecystitis episodes nor stent-/fistula-related occlusions (range of follow up 2 weeks to 24 months). Conclusion: In our experience, technical and clinical outcomes are similar between both TA and TD approaches with no recurrence of cholecystitis nor long term adverse events.