Safety and clinical outcomes of endoscopic ultrasound-guided gallbladder drainage with lumen-apposing metal stents in patients with dwell time over one year

Abstract

Background: Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has proved effective in patients with cholecystitis at high surgical risk. The long-term risks of gallstone-related disease and stent-related adverse events are unknown.

Methods: We performed a retrospective evaluation of a case series including subjects who underwent EUS-GBD using lumen-apposing metal stents (LAMS). Patients were identified from a prospective LAMS registry at a single tertiary center. Patients with a stent indwell time <1 year were excluded. Data regarding stent deployment and adverse events were retrieved from the prospective LAMS registry, while emergency room visits, admissions and causes of death were retrieved from electronic medical records.

Results: We included 22 patients with a median age of 88.3 years (interquartile range [IQR]: 82.6-92.7), 14 (63.6%) were male. Median follow up was 24.4 months (IQR: 18.2-42.4) and median time to the last available imaging procedure was 607 days (IQR: 463-938). No LAMS-related adverse events were identified beyond the first year of follow up. During follow up, 12 patients (54.5%) visited the emergency room 34 times (1 visit/patient, IQR: 0-3) and a total of 36 hospital admissions were required, with a median of 1 admission/patient (IQR: 0-3). Fourteen (63.6%) patients died during follow up. Only 1 patient (4.5%) required new hospital admissions for gallstone-related disease.

Conclusions: There were no adverse events beyond the first year after stent deployment, with only 4.5% of subjects requiring gallstone-related admissions. Permanent EUS-GBD with LAMS may be a definitive treatment for acute cholecystitis in patients ineligible for cholecystectomy.

Keywords: Cholecystitis; digestive system; drainage; endoscopy; stents.

Figure 1

Flowchart showing patient selection EUS, endoscopic ultrasound; LAMS, lumen-apposing metal stent.

Figure 2

(A) Computed tomography (CT) scan performed for obstructive colonic cancer showing a lumen-apposing metal stent (LAMS) with an indwell time of 4 years. (B) CT scan of a patient with a LAMS indwell time of 27 months

Figure 3

(A) Patent cholecystoduodenostomy employing a 10×10 mm lumen-apposing metal stent (LAMS) 31 months after deployment. (B) Cholecystogastrostomy showing overgrowth 42 months after LAMS deployment

Figure 4

Cholecystogastrostomy with a 15×10 mm lumen-apposing metal stent 61.5 months after deployment, showing a patent fistula with a completely buried stent (A), confirmed by its presence on the abdominal X-ray film (B)