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. 2024 Mar;36(3):351-358.
doi: 10.1111/den.14606. Epub 2023 Jul 3.

Endoscopic ultrasound-guided gallbladder drainage as a first approach for jaundice palliation in unresectable malignant distal biliary obstruction: Prospective study

Benedetto Mangiavillano  1   2 , Jong Ho Moon  3 , Antonio Facciorusso  4 , Jorge Vargas-Madrigal  5 , Francesco Di Matteo  6 , Gianenrico Rizzatti  7 , Luca De Luca  8 , Edoardo Forti  9 , Massimiliano Mutignani  9 , Abed Al-Lehibi  10 , Danilo Paduano  1 , Milutin Bulajic  11 , Francesco Decembrino  12 , Francesco Auriemma  1 , Gianluca Franchellucci  1   13 , Alessandro De Marco  1   13 , Carmine Gentile  1 , Il Sang Shin  3 , Roberta Rea  7 , Marco Massidda  14 , Federica Calabrese  1 , Vincenzo Giorgio Mirante  15 , Andrew Ofosu  16 , Stefano Francesco Crinò  17 , Cesare Hassan  2   13 , Alessandro Repici  2   13 , Alberto Larghi  7
Affiliations

Endoscopic ultrasound-guided gallbladder drainage as a first approach for jaundice palliation in unresectable malignant distal biliary obstruction: Prospective study

Benedetto Mangiavillano et al. Dig Endosc. 2024 Mar.

Abstract

Objectives: Endoscopic retrograde cholangiopancreatography (ERCP) represents the gold standard for jaundice palliation in patients with distal malignant biliary obstruction (DMBO). Biliary drainage using electrocautery lumen apposing metal stent (EC-LAMS) is currently a well-established procedure when ERCP fails. In a palliative setting the endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) could represent an easy and valid option. We performed a prospective study with a new EC-LAMS with the primary aim to assess the clinical success rate of EUS-GBD as a first-line approach to the palliation of DMBO.

Methods: In all, 37 consecutive patients undergoing EUS-GBD with a new EC-LAMS were prospectively enrolled. Clinical success was defined as bilirubin level decrease >15% within 24 h and >50% within 14 days after EC-LAMS placement.

Results: The mean age was 73.5 ± 10.8 years; there were 17 male patients (45.9%). EC-LAMS placement was technically feasible in all patients (100%) and the clinical success rate was 100%. Four patients (10.8%) experienced adverse events, one bleeding, one food impaction, and two cystic duct obstructions because of disease progression. No stent-related deaths were observed. The mean hospitalization was 7.7 ± 3.4 days. Median overall survival was 4 months (95% confidence interval 1-8).

Conclusion: Endoscopic ultrasound-guided gallbladder drainage with the new EC-LAMS is a valid option in palliative endoscopic biliary drainage as a first-step approach in low survival patients with malignant jaundice unfit for surgery. A smaller diameter EC-LAMS should be preferred, particularly if the drainage is performed through the stomach, to avoid potential food impaction, which could result in stent dysfunction.

Keywords: EC-LAMS; Hot-Spaxus; drainage: EUS-GBD; interventional EUS; malignant biliary obstruction (MBO).

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References

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