With the introduction of new LAMS, EUS guided gallbladder (GB) drainage is now becoming a viable alternative to percutaneous GB drainage with favourable clinical success rates and potentially fewer adverse events.Methods
Patients with cholecystitis who were not surgical candidates due to advanced malignancy or severe co-morbidities underwent EUS guided GB drainage in a single centre from April 2017 till OCT 2017. LAMS 15 mmx10 mm with the electrocautery-enhanced delivery system were used in all patients.Results
A total of 6 patients with a median age was 65 years (range, 58–93). Three patients had severe cardiovascular disease and rest had advanced hepatobiliary malignancy. The Charlson Comorbidity Index median value 8 (4–10). Cholecystitis was graded moderate in three patients and mild in three per the Tokyo guidelines. Three patients were performed as primary GB drainage, and three were performed as endoscopic internalisation of prior percutaneous biliary drainage. LAMS deployment was technically successful in four patients. Two patients had contrast extravasation on the initial filling of GB via the percutaneous drain and after needle puncture respectively. As the GB was not distended in each case, the respective procedures were aborted and referred for surgical management. Of the four deployed stents, one had the proximal flange obstructing the pylorus, and this was treated with another LAMS deployed at the pylorus to prevent gastric outlet obstruction. There was no periprocedural complication. The median duration of the successful procedures was 33.5 min (20–83). Three patients had advanced malignancy, so the LAMS was left permanently. One patient had transmural stone extraction through the LAMS. During this procedure, a stone migrated into the common bile duct. This patient underwent ERCP and LAMS removal at one month after placement. One patient had severe abdominal pain due to post-procedure bile leak and was treated conservatively with intravenous antibiotics. The overall success rate was 67% (4/6). Of the four successfully deployed LAMS, clinical success was observed in all.Conclusions
GB drainage using LAMS is technically feasible for non-surgical candidates with cholecystitis. Inability to distend the GB adequately for safe LAMS deployment was the main reason for the failure of the procedure.