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.
Kim_headshot

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).

Kim-fig

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.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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