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Updated: May 25, 2025
Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
EUS-guided gallbladder drainage vs dual stent transpapillary gallbladder drainage for management of acute
Dhruval Amin1, Katherine M Cooper1, Prashanth Rau1
1Medicine, Division of Gastroenterology and Hepatology, UMass Chan, Worcester, United States.
Insights
Dual transcystic stent gallbladder drainage (DSET-GBD) shows comparable recurrence rates to endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) for acute cholecystitis. DSET-GBD offers a viable alternative for non-surgical candidates.
Area of Science:
- Gastroenterology
- Minimally Invasive Procedures
- Biliary Interventions
Background:
- Cholecystectomy is standard for acute cholecystitis.
- Percutaneous drainage has high readmission rates.
- Endoscopic techniques offer alternatives for non-surgical patients.
Purpose of the Study:
- Compare dual transcystic stent gallbladder drainage (DSET-GBD) with endoscopic ultrasound-guided gallbladder drainage (EUS-GBD).
- Evaluate outcomes in non-surgical patients with acute cholecystitis.
Main Methods:
- Multicenter analysis of 129 patients undergoing ET-GBD or EUS-GBD (Jan 2019-Jan 2023).
- Data extracted from electronic medical records.
- Outcomes measured: technical success, clinical success, adverse events, recurrence rates.
Main Results:
- Technical success rates were similar: 87.5% (EUS-GBD) vs. 86.3% (ET-GBD).
- Immediate clinical success: 98.1% (EUS-GBD) vs. 100% (DSET-GBD).
- Adverse event and cholecystitis recurrence rates were comparable between EUS-GBD and DSET-GBD.
Conclusions:
- Dual transcystic stent gallbladder drainage (DSET-GBD) demonstrates similar low recurrence rates to EUS-GBD.
- DSET-GBD is a viable alternative for managing acute cholecystitis in non-surgical candidates.
Background And Study Aims:
Cholecystectomy (CCY) is the standard treatment for acute cholecystitis. For non-surgical patients, percutaneous cholecystostomy tube (PT-GBD) is recommended but is associated with high readmission rates and poor quality of life. Endoscopic gallbladder decompression techniques, including endoscopic transpapillary gallbladder drainage (ET-GBD) and endoscopic ultrasound-guided gallbladder drainage (EUS-GBD), are alternatives. Studies comparing ET-GBD and EUS-GBD have shown EUS-GBD to have superior outcomes. However, these studies assessed ET-GBD mostly via single transcystic stent placement (SSET-GBD). This study aimed to compare outcomes of dual transcystic stents (DSET-GBD) and EUS-GBD in non-surgical candidates with acute cholecystitis.
Patients And Methods:
A multicenter analysis was conducted on patients who underwent ET-GBD or EUS-GBD between January 2019 and January 2023. Data were extracted from electronic medical records and outcomes including technical success, success, adverse events (AEs), and recurrence rates of cholecystitis were measured.
Results:
Of 129 procedures (56 EUS-GBD; 73 ET-GBD), technical success was achieved in 87.5% of EUS-GBD and 86.3% of ET-GBD attempts. Immediate clinical success was achieved in 98.1% for EUS-GBD and 100% for DSET-GBD. AE rates were similar between the groups. Recurrent cholecystitis rates were 5.3% for EUS-GBD and 8.2% for DSET-GBD ( P = 0.692).
Conclusions:
This study demonstrates that DSET-GBD has similarly low rates of recurrent acute cholecystitis compared with EUS-GBD. DSET-GBD should be considered as an alternative management strategy for management of acute cholecystitis in patients who are unable to undergo CCY.
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