SAN DIEGO—Endoscopic ultrasound–guided gallbladder drainage using lumen-apposing metal stents as a salvage therapy after failed endoscopic retrograde cholangiopancreatography is associated with high technical and clinical success in patients with distal malignant biliary obstruction, according to data presented at DDW 2025.
Investigators at Wake Forest University School of Medicine, in Winston-Salem, N.C., conducted a retrospective study to evaluate EUS-GBD with LAMS as a salvage therapy in this patient population. They used data from consecutive patients at their center who underwent same-session ERCP and EUS-GBD between July 2019 and September 2024.
Among the 25 total patients, 18 survived to 30 days post-procedure. Those who survived to 30 days had a lower median ASA (American Society of Anesthesiologists) physical status classification than those who did not (3.0 vs. 4.0; P<0.01). However, there were no statistically significant differences between the groups in other baseline characteristics, such as age (65.5 vs. 64.0 years), gender (61.1% vs. 71.4% male), baseline Charlson Comorbidity Index (6.0 vs. 7.0), prior anticoagulant use (16.7% vs. 28.6%) and prior antiplatelet use (33.3% vs. 0.0%).
{RELATED-VERTICAL}Pre-procedure laboratory findings also were comparable among those who survived to 30 days and those who did not, aside from lower leukocyte counts (7.7?103 vs. 17.57?103/mcL; P=0.04) and higher albumin levels (3.2 vs. 2.9 g/dL; P<0.01) among those who survived.
Technical success, defined as successful placement of the LAMS in the gallbladder lumen, was achieved in all 25 patients in the study. Clinical success, defined as a decrease by at least 50% in total bilirubin within two weeks post-procedure, was achieved in 88.9% of those who survived to 30 days and 83.3% of those who did not (P=0.99). However, there was a greater absolute change in bilirubin post- versus pre-procedure among those who survived to 30 days (–9.25 vs. –5.55 mg/dL; P=0.03).
The incidence of adverse events was comparable (11.1% in those who survived 30 days vs. 28.6% in those who did not; P=0.55). In addition, the duration of the procedure and post-procedure length of stay also were comparable across groups.
Across the entire study population of patients who underwent EUS-GBD salvage therapy, median survival was 65 days. When assessing factors associated with overall survival in these patients, the investigators found that having an ASA score of IV, relative to II, was associated with 36.11 times the hazard of overall survival (95% CI, 2.80-466.31), which suggests the ASA score may have predictive value.
—Natasha Albaneze, MPH