Endoscopic ultrasound‐guided gallbladder drainage as a first approach for jaundice palliation in unresectable malignant distal biliary obstruction: Prospective study

Benedetto Mangiavillano, Jong Ho Moon, Antonio Facciorusso, Jorge Vargas‐Madrigal, Francesco Di Matteo, Gianenrico Rizzatti, Luca De Luca, Edoardo Forti, Massimiliano Mutignani, Abed Al‐Lehibi, Danilo Paduano, Milutin Bulajic, Francesco Decembrino, Francesco Auriemma, Gianluca Franchellucci, Alessandro De Marco, Carmine Gentile, Il Sang Shin, Roberta Rea, Marco Massidda, Federica Calabrese, Vincenzo Giorgio Mirante, Andrew Ofosu, Stefano Francesco Crinò, Cesare Hassan, Alessandro Repici, Alberto Larghi

Endoscopic retrograde cholangiopancreatography (ERCP) represents the gold standard for jaundice palliation in patients with distal malignant biliary obstruction (DMBO) . Biliary drainage using electrocautery lumen apposing metal stent (EC-LAMS) is currently a well-established procedure when ERCP fails. In a palliative setting the endoscopic ultrasound gallbladder drainage (EUS-GBD) should represent an easiest and valid option. We performed a prospective study with a new EC-LAMS with the primary aim to assess the clinical success rate of EUS-GBD as first-line approach to the palliation of DMBO. 37 consecutive patients undergoing EUS-GBD with a new EC-LAMS were prospectively enrolled. Clinical success was defined as bilirubin level decrease >15% within 24 hours and >50% within 14 days after EC-LAMS placement. Mean age was 73.5±10.8 years; male patients were 17 (45.9%). EC-LAMS placement was technically feasible in all of the patients (100%) and clinical success rate was 100%. 4 patient (10.8%) experienced adverse events (AEs), one bleeding, one food impaction and two cystic duct obstructions because of the disease progression. No stent-related deaths were observed. The mean of hospital stay was 7.7± 3.4 days. Median overall survival was 4 months (95% CI 1-8). EUS-GBD with the new EC-LAMS is a valid option in palliative endoscopic biliary drainage as first-step approach in low survival patients with malignant jaundice unfit for surgery. A smaller diameter EC-LAMS should be preferred, particularly if the drainage is performed through the stomach, to avoid potentially food impaction, which could result in stent dysfunction.