Michael Makar, MD1, Michael Yodice, MD1, Idorenyin Udoeyo, MPH1, David L. Diehl, MD1, Harshit S.. Khara, MD, FACG2, Bradley D.. Confer, DO1 1Geisinger Health System, Danville, PA; 2Geisinger Medical Center, Danville, PA
Introduction: Endoscopic ultrasound-guided gallbladder drainage (EUS-GB) using lumen-apposing metal stents (LAMS) has become an important treatment option for patients with cholecystitis who are not surgical candidates. Concurrent double-pigtail plastic stent (DPPS) deployment has been suggested to prevent adverse events such as bleeding or obstruction. This study aimed to compare the clinical outcomes of EUS-GB of LAMS with DPPS vs LAMS alone.
Methods: This was a retrospective study of patients undergoing EUS-GB between 2018 to 2023 in a large academic hospital center. Data was collected regarding procedural characteristics, clinical and technical success, adverse events, length of stay (LOS) and overall mortality. Technical success was defined as successful deployment of the LAMS to the intended location. Clinical success was defined as improvement in patient symptom and lab parameters. Groups were compared using a Chi-square, Fisher’s exact test, an independent two-sample t-test and Mann-Whitney test, where appropriate. Multivariate regression analysis was done for factors associated with clinical success. A p< 0.05 was considered significant.
Results: 177 patients were included (48.6% female, mean age 79.1). LAMS alone was used in 91 patients (51.4%) and LAMS/DPPS in 86 (48.6%). Technical success was achieved in 100% of LAMS alone and 96.5% in LAMS/DPPS (p=0.113), and clinical success in 97.8% for LAMS alone vs 94.2% in LAMS/DPPS (p=0.268). Those with LAMS/DPPS were more likely to undergo dilation (74.4% vs 46.2%, p=0.001). There was no significant difference in overall adverse events between the two groups (15.4% vs 14%, p=0.788), recurrent cholecystitis (7.7% vs 11.6%, p=0.375), LOS (6 days vs 7 days) or mortality. In a multivariable model the only factor associated with clinical success was initial dilation (OR 6.2 [1.1-35.1], p=0.04).
Discussion: Placement of coaxial DPPS for EUS-GB did not affect adverse events or clinical outcomes. In multivariable analysis initial dilation was significantly associated with clinical success. Additional larger studies are necessary to confirm these findings.
Note: The table for this abstract can be viewed in the ePoster Gallery section of the ACG 2024 ePoster Site or in The American Journal of Gastroenterology's abstract supplement issue, both of which will be available starting October 27, 2024.
Disclosures:
Michael Makar indicated no relevant financial relationships.
Michael Yodice indicated no relevant financial relationships.
Idorenyin Udoeyo indicated no relevant financial relationships.
David Diehl: Castle Biosciences – Consultant.
Harshit Khara: Boston Scientific – Consultant. Castle Biosciences – Consultant. ConMed – Consultant. Cook Medical – Consultant. Medtronic – Consultant. Neptune Medical – Consultant. Olympus America – Consultant. Pentax – Consultant.
Bradley Confer: Boston Scientific Corporation – Consultant. Exact Sciences – Advisory Committee/Board Member, FDA advisory panel.
Michael Makar, MD1, Michael Yodice, MD1, Idorenyin Udoeyo, MPH1, David L. Diehl, MD1, Harshit S.. Khara, MD, FACG2, Bradley D.. Confer, DO1. P2763 - Are Double-Pigtail Plastic Stents Beneficial for Endoscopic Ultrasound Guided Gallbladder Drainage with Lumen Apposing Metal Stents?, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
