Safety and Effectiveness of EUS-Guided Gallbladder Drainage in Patients with Cirrhosis: An International Multicenter Experience

Introduction EUS-guided gall bladder drainage (EUS-GBD) for management of symptomatic gallbladder disease has been shown to be safe and effective in high surgical risk patients with data lacking in patients with cirrhosis. We sought to study the safety and effectiveness of EUS-GBD in cirrhotic compared to non-cirrhotic patients. Methods Retrospective review of patients who underwent EUS-GBD at four (3 US and 1 Spain) international tertiary care centers. We collected baseline variables with outcomes being procedural technical success, clinical success and procedure related adverse events. Outcomes were compared between patients with and without cirrhosis. Results A total of 170 patients (47 cirrhotics, 123 non cirrhotic) were included. There was no difference in age, gender, race, comorbidities, antiplatelet use, hemoglobin, international normalized ratio between the two groups (p>0.05 for all). The most common etiology of cirrhosis was alcoholic (42.6%) with mean MELD-Na score of 16.2 ± 8.8. Acute cholecystitis was a more common indication of EUS-GBD in cirrhotics (74.5% vs. 56.9%, p=0.02). Technical (97.9% vs. 95.1%, p=0.67) and clinical success (93.6% vs. 94.9%, p=0.71) rates were similar in both cirrhosis and no cirrhosis groups. Adverse events were infrequent and did not differ between groups with the most common being stent maldeployment (4.3% in cirrhosis vs. 5.7%, in no cirrhosis group, p=0.99). Survival rates were similar at the end of follow up. Conclusion Our international multicenter experience suggests EUS-GBD is safe and effective in patients with cirrhosis, with outcomes similar to patients without cirrhosis when performed by experienced echoendoscopists. Patients with cirrhosis and symptomatic gallbladder disease can be considered for EUS-GBD.