Percutaneous transhepatic versus EUS-guided gallbladder drainage

Post written by Jaihwan Kim, MD, from the Seoul National University College of Medicine, Seoul National University Bundang Hospital.

We want to introduce the feasibility, safety, long-term patency, and economic issue of EUS-GBD in patients with malignant cystic duct obstruction.

In real practice, physicians meet some patients who need a long indwelling PTGBD which seriously worsens quality of life. EUS-GBD is a novel and pioneering interventional technique compared to PTGBD, which is a standard technique. However, I believe that it can be a solution for such patients who need a long indwelling percutaneous catheter.

There were several studies about EUS-GBD in which feasibility and safety issues were already studied. In this study, the outcomes of EUS-GBD were comparable to those of PTGBD. In patients with malignant cystic obstruction, the technical and clinical success rates of the EUS-GBD and PTGBD groups were 85.7% (12/14) and 91.7% (11/12) and 100% (19/19) and 86.4% (17/19), respectively. The groups had similar adverse event rates (28.5% and 21.1%, respectively). The average duration of stent patency in patients with EUS-GBD was 59.5 ± 8.7 weeks, and no patient required an additional procedure until death. In 6 of 17 patients (35.3%) with clinically successful PTGBD, the catheter was not removed until their end stage of life. In addition, the length of hospital stay after procedure significantly differed between the 2 procedures (EUS-GBD group, median 5 days [2–16] and PTGBD group, 12 days [5–35]; P=.002) without difference of the total sum of the cost of hospital stay and procedure (EUS-GBD group, median $2,096 [$1,864–3,452] and PTGBD group, $1,975 [$1,257–3,845]; P=.215).


Figure 1. All patients with clinically successful EUS-guided gallbladder drainage had internal metal stent placement without additional procedures. In
patients with percutaneous transhepatic gallbladder drainage, catheter removal was possible in 11 patients, and cholecystectomy was performed in 2
patients. Six patients had to maintain the catheter permanently. EUS-GBD, Endoscopic ultrasound-guided gallbladder drainage; PTGBD, percutaneous
transhepatic gallbladder drainage.

We think that the next study should be a prospective, randomized, controlled study for patients with malignant cystic obstruction or patients in a bed-ridden state who are not appropriate candidates for cholecystectomy.

It is a great experience to published in GIE. I hope our article will be a clue to new and innovative interventional techniques which will eventually be helpful to patients.

Find the article abstract here.

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