Prophylactic EUS-guided gallbladder drainage prevents acute cholecystitis in patients with malignant biliary obstruction and cystic duct orifice involvement: a randomized trial (with video)

Post written by Carlos Robles-Medranda, MD, from the Instituto Ecuatoriano de Enfermedades Digestivas, Guyaquil, Ecuador.


This study focuses on the benefits of prophylactic EUS-guided gallbladder drainage (EUS-GBD) in patients with unresectable malignant biliary obstruction (MBO) and occlusion of the orifice of the cystic duct (OCD).

Although acute cholecystitis (AC) will not always develop in patients with MBO and OCD tumor involvement, up to 25% of these patients may experience it, thus increasing morbidity and negatively impacting their overall quality of life. The latter is especially true for oncologic patients.

In addition, antibiotic therapy does not warrant AC symptom resolution. Therefore, prophylactic EUS-GBD in patients with a high risk for developing AC does not only alter prognosis, but it also is a cost-saving intervention with the avoidance of unexpected admissions and prolonged hospital stays.

In our study, 22 patients were allotted to each cohort (44 in total). None of the patients in the intervention group experienced AC versus 22.7% in the control group, and median hospitalization time was significantly lower in the intervention group (2 days vs 1 day, P = .017). Also, no difference in median survival rates was observed in the primary EUS-GBD group (2.9 months) and the control group (2.8 months) (P = .580).

Prophylactic EUS-GBD demonstrated a reduced incidence of AC in this very specific patient subset and proved to be safe and effective. Consequently, prophylactic EUS-GBD is proposed as a new indication for the prevention of AC in high-risk patients.

Nonetheless, larger multicenter studies may be required to further assess EUS-GBD’s cost-effectiveness and potential in becoming the new standard of care in such patients. In addition, thorough evaluation of pertinent associated risk factors for AC in MBO (eg, occlusion of the OCD and/or type of self-expandable metallic stent [SEMS] used) should occur.

Sample size was estimated with a 10% margin error and a 95% confidence interval per the 6.1% AC rate after SEMS placement reported by Shimizu et al.

Robles_figureA, Cumulative curve indicating the occurrence of acute cholecystitis in the intervention and control groups over the follow-up period. B, Kaplan-Meier survival curves of each group.

Read the full article online.

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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