Electrocautery-Enhanced Delivery System of Lumen Apposing Metal Stent for EUS-Guided Biliary and Gallbladder Drainage: A Single-Center Study

Aims We aimed to evaluate the feasibility and safety of lumen-apposing metal stents for EUS-guided biliary and gallbladder drainage.

Methods An observational, retrospective study from a single tertiary institution (Jun 2018 to August 2020). The technical success was defined by the successful completion of the intended procedure by the placement of the LAMS in the intended position. Management of technical failures was recorded. Safety was defined as the occurrence of procedure-related related adverse events in accordance with the ASGE Lexicon. Adverse event management was recorded.

Results Seventy-seven patients were included for analysis: 40/77 were EUS-guided gallbladder drainages, 17/77 EUS-guided biliary drainages and 20/77 patients received combined EUS-guided gallbladder and biliary drainage on the same session. Regarding gallbladder drainage, 34/60 (56.7 %) were performed for the management of acute cholecystitis. Regarding biliary drainage, 11/37 (29.7 %) patients were submitted following a failed ERCP in comparison to 26/37 (70.3 %) in whom EUS-guided biliary drainage was offered as a first-line modality for achieving biliary drainage. In those patients with biliary drainage, the draining site was common bile duct 77.14 %, left intrahepatic duct 20 % and right intrahepatic duct 2.8 %. The baseline total bilirubin level was 18.3 mg/dL. Following EUS-guided biliary drainage we found a statistically significant decrease in bilirubin level at 1-week (median level 10.6 mg/dL) and 4-week follow-up (median level 2.38 mg/dL) (<0.001). Overall, 74/77 (96.1 %) of patients achieved technical success. Three patients required a reintervention following failed EUS-guided procedure: 2 of 3 LAMS were misdeployed, the tracks were closed with an OTSC and one retreated using a fully covered metallic biliary stent. No clinical adverse events were reported on follow-up.

Conclusions EUS-guided biliary drainage using LAMS is a feasible, effective, and safe procedure for the management of palliative biliary drainage. EUS-guided gallbladder drainage is a safe and effective alternative for the management of gallbladder disorders.

Citation: Robles-Medranda C, Oleas R, Alcivar-Vasquez J et al. OP163 ELECTROCAUTERY-ENHANCED DELIVERY SYSTEM OF LUMEN APPOSING METAL STENT FOR EUS-GUIDED BILIARY AND GALLBLADDER DRAINAGE: A SINGLE-CENTER STUDY. Endoscopy 2021; 53: S66.

Publication History

Article published online:
19 March 2021