Single-session endoscopic retrograde cholangiopancreatography and endoscopic ultrasound—guided gallbladder drainage for management of biliary obstruction and gallbladder disease

Abstract

Background and Aims

Conventional management of biliary obstruction is endoscopic retrograde cholangiopancreatography (ERCP) followed by cholecystectomy to prevent recurrent biliary events, particularly when the indication is choledocholithiasis. In nonsurgical candidates, endoscopic ultrasound (EUS)—guided gallbladder drainage (EUS-GBD) is a first-line alternative for gallbladder decompression. Single-session ERCP and EUS-GBD provides definitive management of biliary obstruction and prevention of future biliary adverse events (AEs) without the need for surgical cholecystectomy or repeat intervention. Our study is the first in the United States to evaluate outcomes of patients who underwent ERCP and EUS-GBD for management of both malignant and benign biliary disease.

Methods

This is a retrospective review of patients who underwent single-session ERCP and EUS-GBD at the University of North Carolina from January 1, 2014, to November 1, 2023. Patient demographics, comorbidities, procedure details, and follow-up were recorded. Outcomes included technical and clinical success, short and long-term AEs, need for reintervention, and death.

Results

During the study period, 37 patients were included. Indications for ERCP and EUS-GBD were choledocholithiasis and cholelithiasis in 24 patients, malignant biliary obstruction and concomitant cholecystitis in 9, and benign biliary stricture and concomitant cholecystitis in 4. The mean (standard deviation) Charlson Comorbidity Index was 7.1 (2.6). Technical success for EUS-GBD was 97.3%, and overall clinical success for combined ERCP and EUS-GBD was 86.5%. Three early (8.1%) and 1 late (2.7%) AEs occurred. Early AEs included stent misdeployment, duodenal perforation, and post-ERCP fever. The late AE involved stent migration. None of the AEs resulted in mortality. Mean follow-up time was 312 (407) days. Four patients (10.8%) required a procedure for reintervention and 1 patient required a follow-up surgery. No patients required a follow-up surgical cholecystectomy.

Conclusions

Single-session ERCP and EUS-GBD appears effective for the management of both benign and malignant biliary obstruction and concomitant gallbladder disease with minimal AEs and without the need for surgical cholecystectomy. Larger prospective studies are needed to confirm these early findings.