This content is available to ASGE Members only. If you are member, please login to access the content. If you are not a member, learn about joining ASGE
Journal-Banner_rev

Prevention of Cholecystitis in Patients Undergoing ERCP for Malignant Distal Biliary Obstruction Involving the Cystic Duct: A Novel Technique

Vanessa M. Shami, MD, FASGE reviewing Robles-Medranda C, et al. Gastrointest Endosc 2022 Oct 31.

Cholecystitis following biliary drainage with a self-expandable metallic stent (SEMS) in patients with distal malignant biliary obstruction (MBO) and cystic duct orifice involvement is significant. Interventions such as placing a cystic duct stent during ERCP can decrease the risk. This single-center, randomized, controlled trial investigated whether the placement of an endoscopic ultrasound (EUS)-guided gallbladder drain prevents the occurrence of acute cholecystitis in patients undergoing SEMS biliary decompression for MBO involving the cystic duct. The secondary outcomes were the length of hospitalization and median survival time.

Forty-four patients with MBO and cystic duct involvement were enrolled from July 2018 to July 2020. Twenty-two patients were randomized to the intervention group and were treated with conventional ERCP biliary drainage with SEMS placement, followed by primary EUS-guided gallbladder drainage (EUS-GBD). The other 22 patients (control group) were treated with only conventional biliary drainage. 

No patients in the intervention group versus 5 (22.7%) in the control group developed acute cholecystitis (P=.049). The median hospitalization time was significantly lower in the intervention group than in the control group (1 day vs 2 days; P=.017). There was no difference in the median survival rates between the 2 groups (2.9 months in the intervention group vs 2.8 months in the control group; P=.580).


Comment:

EUS-GBD appears to lower the risk of acute cholecystitis in patients with unresectable MBO and cystic duct orifice obstruction. The number needed to treat based on this small study (N=44) was 4.4. It is unclear whether the risks and costs associated with this procedure justify its benefit. Future large randomized controlled studies are needed to confirm these findings.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
https://www.asge.org/images/default-source/journal-scan/shami.jpg?sfvrsn=e5d03353_0

Vanessa M. Shami, MD, FASGE

Bio and Disclosures

Citation(s):

Robles-Medranda C, Oleas R, Puga-Tejada M, et al Prophylactic EUS-guided gallbladder drainage prevents acute cholecystitis in patients with malignant biliary obstruction and cystic duct orifice involvement: a randomized trial (with video). Gastroint Endosc 2022 Oct 31. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2022.10.037)