# A233 CANADIAN EXPERIENCE OF ENDOSCOPIC ULTRASOUND-GUIDED GALLBLADDER DRAINAGE: A CASE SERIES

## TL;DR

This case series shows that EUS-guided gallbladder drainage is a safe and effective treatment for high-risk patients in Canada.

## Contribution

The study provides the first Canadian data on EUS-GBD outcomes in elderly, high-risk patients.

## Key findings

- EUS-GBD was technically successful in all 18 cases with symptom and biochemical improvement.
- Three post-procedural complications occurred but were managed without surgical or percutaneous intervention.
- No patients required cholecystectomy, and no deaths were procedure-related.

## Abstract

Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is an emerging treatment for acute cholecystitis in patients who are poor surgical candidates. There is a lack of EUS-GBD data in the Canadian setting, which may differ from its global counterparts in pattern of healthcare availability, aging population, and use of conscious sedation.

To describe outcomes following EUS-GBD in the Canadian setting.

The case series included patients undergoing EUS-GBD by an interventional gastrointestinal endoscopist in a tertiary academic centre in Canada. Data included were clinicodemographic information, procedural details, and clinical outcomes.

From September 2023 to September 2024, a total of 18 patients underwent EUS-GBD. Median age was 85 (IQR 75-88) years, 6 (33%) were female, and 17 (94%) were American Society of Anesthesiologists Physical Status (ASA) classification III. Indication included 15 cases of acute calculous cholecystitis and 3 (17%) cases of salvage treatment for malignant biliary obstruction without alternative access. Placement was transduodenal in 10 (56%) and transgastric in 8 (44%). A coaxial double pigtail was placed in 15 cases (83%). Conscious sedation was used for 15 cases (83%), with 1 case using deep sedation with propofol and 2 with general anesthesia. All cases were technically successful followed by improvement of symptoms and biochemistry. There were no intra-procedural complications, but 3 post-procedural complications were noted. One patient had recurrent cholecystitis after 1 month due to stent occlusion despite coaxial pigtail placement, which was managed endoscopically with symptom resolution. Another patient had a buried stent, which was managed with placement of a second lumen-apposing metal stent within the first stent. A third patient had pain post-procedure suspected due to stent expansion, which self-resolved within 2 weeks. No rescue percutaneous or surgical interventions were required following EUS-GBD. No patients underwent subsequent cholecystectomy. Four patients died from underlying systemic disease, including 3 patients who underwent EUS-GBD for malignant obstruction with no recurrent cholecystitis up to time of death at 15-150 days post-procedure.

In an elderly population and using primarily conscious sedation, EUS-GBD was safe and effective in patients with high surgical risk, underscoring the suitability of this technique for a Canadian setting.

A. Gallbladder with debris/sludge on EUS. B. Distal flange of lumen apposing metal stent (LAMS) deployed within gallbladder lumen. C. Proximal flange deployed in duodenum. D. Coaxial double pigtail placed within LAMS.

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