P3529 - Effectiveness and Safety of EUS-Guided Gallbladder Drainage vs EUS-Guided Bile Duct Drainage in Patients With Malignant Biliary Obstruction After Failed ERCP: A Propensity-Score Matched International Multicenter Study

Award: ACG Outstanding Research Award in the Interventional Endoscopy Category (Trainee)

Award: ACG Presidential Poster Award

Daryl Ramai, MD, MPH, MSc¹, Benedetto Mangiavillano, MD², Francesco Auriemma, MD², Danilo Paduano, MD², Alessandro Fugazza, MD³, Gianluca Franchellucci, MD³, Alessandro Repici, MD³, Marco Spadaccini, MD⁴, Carmelo Barbera, MD⁵, Vanella Giuseppe, MD⁶, Germana De Nucci, MD⁷, Andrew Fuller, MD⁸, Christopher Ko, MD⁹, John Morris, MD⁹, Belén Martínez-Moreno, MD¹⁰, Roberto Di Mitri, MD¹¹, Serena Stigliano, MD¹², Francesco Di Matteo, MD¹³, Alberto Larghi, MD¹⁴, Carlos Robles Medranda, MD¹⁵, Martha Arevalo-Mora, MD¹⁶, Andrea Anderloni, MD¹⁷, Francesco Minini, MD¹⁸, Carmine Gentile, MD¹⁸, Federica Calabrese, MD¹⁸, Luca De Luca, MD¹⁹, Anthony Teoh, MD²⁰, Jorge Vargas-Madrigal, MD²¹, Camilla Gallo, MD²², Edoardo Forti, MD²³, Massimiliano Mutignani, MD²⁴, Michiel Bronswijk, MD²⁵, Schalk Van der Merwe, MD²⁶, Helga Bertan, MD²⁷, Giovanni Aragona, MD²⁸, Edoardo Troncone, MD²⁹, Sundeep Lakhtakia, MD³⁰, Stefano Crinò, MD³¹, Cesare Hassan, MD³², Antonio Facciorusso, MD, PhD³³
1Brigham and Women’s Hospital, Harvard Medical School, Salt Lake City, UT; 2Humanitas Mater Domini, Castellanza, Campania, Italy; 3IRCCS Humanitas Research Hospital, Rozzano, Trentino-Alto Adige, Italy; 4Umberto I Hospital, Siracusa SR, Lazio, Italy; 5Ospedale G. Mazzini, Teramo, Trentino-Alto Adige, Italy; 6IRCCS San Raffaele Scientific Institute, Milan, Trentino-Alto Adige, Italy; 7Aziende Socio Sanitaria Territoriale Rhodense, Milan, Trentino-Alto Adige, Italy; 8University of Utah Health, Salt Lake City, UT; 9University of Utah, Salt Lake City, UT; 10Hospital General Universitario de Alicante, Alicante, Andalucia, Spain; 11A.R.N.A.S. Ospedali Civico Di Cristina Benfratelli, Pallmero, Veneto, Italy; 12Campus bio-medico university hospital, Roma, Veneto, Italy; 13Campus Bio-Medico University Hospital, Roma, Veneto, Italy; 14Universita Cattolica del Sacro Cuore, Rome, Veneto, Italy; 15Instituto Ecuatoriano de Enfermedades Digestivas, Guayaquil, Guayas, Ecuador; 16Larkin Community Hospital, South Miami, FL; 17Fondazione IRCCS Policlinico San Matteo, Pavia, Veneto, Italy; 18Humanitas Mater Domini, Castellanza, Veneto, Italy; 19ASST Santi Paolo e Carlo, Milan, Veneto, Italy; 20Prince of Wales Hospital, Hong Kong, Hong Kong; 21Enrique Baltodano Briceno Hospital, Costa Rica, San Jose, Costa Rica; 22University of Milano-Bicocca, Monza, Veneto, Italy; 23Ospedale Niguarda- Ca' Granada, Milan, Veneto, Italy; 24Ospedale Niguarda-Ca' Granda, Milan, Veneto, Italy; 25University Hospitals Leuven, Leuven, Limburg, Belgium; 26University Hospitals Leuven, Leuven, Luxembourg, Belgium; 27Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Veneto, Italy; 28Hospital of Piacenza, Piacenza, Veneto, Italy; 29University of Rome, Rome, Veneto, Italy; 30AIG Hospital, Hyderabad, Chandigarh, India; 31University of Verona, Verona, Veneto, Italy; 32IRCCS Humanitas Research Hospital, Rozzano, Veneto, Italy; 33University of Salento, Salento, Veneto, Italy

Introduction: It is unclear which is the best approach for the drainage of malignant distal biliary obstruction (MDBO) after failed endoscopic retrograde cholangiopancreatography (ERCP). We compared endoscopic ultrasound (EUS)–guided gallbladder drainage (GBD) and EUS-guided choledocoduodenostomy (CDS) with lumen-apposing metal stents (LAMS) as rescue treatment in the case of ERCP failure.

Methods: This was an international multicenter retrospective observational study at 28 tertiary-care centers through August 2024. Outcomes were compared using propensity score matching. Clinical success was the primary outcome, with technical success, adverse event (AE) rate and overall survival being the secondary outcomes.

Results: Five hundred twenty-nine patients underwent EUS guided drainage of which 136 patients underwent EUS-GBD, and 393 patients underwent EUS-CDS. After 1-to-1 propensity score matching, 224 patients were selected (112 per group). Mean age was 76 years in both groups (p=0.9) and 49 (43.7%) and 48 (42.8%) male patients were treated with EUS-GBD and EUS-CDS, respectively (p=0.9). EUS-GBD and EUS-CDS had similar technical success (97.3% and 91%; p=0.08) and clinical success rates (83% and 85.7%; p=0.17). AE rate was 19.6% in the EUS-GBD group and 12.5% in the EUS-CDS group (p=0.20), of which 10 (8.9%) and 7 (6.2%) severe AEs respectively (p=0.61). Bleeding occurred in seven patients (6.1%) after EUS-GBD and 3 patients (2.5%) after EUS-CDS whereas 5 infectious events were registered after EUS-GBD (4.4%) and 4 cases (3.5%) after EUS-CDS (p=0.29). No treatment related deaths were observed. Median overall survival was 5 months (4-7) in the EUS-GBD group and 5.5 months (5-7) in the EUS-CDS group (p=0.55).

Discussion: Our study showed that in patients with MDBO after failed ERCP, EUS-GBD or EUS-CDS were comparable with similar rates of efficacy and safety. EUS-GBD could represent an easy and safe option in MDBO patients without previous cholecystectomy and with a clear patency of the cystic duct.


Figure: Figure: Kaplan-Meier curve comparing overall survival between the two groups


Figure: Table: Study outcomes of EUS-bile duct drainage and EUS-gallbladder drainage

Disclosures:
Daryl Ramai indicated no relevant financial relationships.
Benedetto Mangiavillano indicated no relevant financial relationships.
Francesco Auriemma indicated no relevant financial relationships.
Danilo Paduano indicated no relevant financial relationships.
Alessandro Fugazza indicated no relevant financial relationships.
Gianluca Franchellucci indicated no relevant financial relationships.
Alessandro Repici indicated no relevant financial relationships.
Marco Spadaccini indicated no relevant financial relationships.
Carmelo Barbera indicated no relevant financial relationships.
Vanella Giuseppe indicated no relevant financial relationships.
Germana De Nucci indicated no relevant financial relationships.
Andrew Fuller indicated no relevant financial relationships.
Christopher Ko indicated no relevant financial relationships.
John Morris indicated no relevant financial relationships.
Belén Martínez-Moreno indicated no relevant financial relationships.
Roberto Di Mitri indicated no relevant financial relationships.
Serena Stigliano indicated no relevant financial relationships.
Francesco Di Matteo indicated no relevant financial relationships.
Alberto Larghi indicated no relevant financial relationships.
Carlos Robles Medranda indicated no relevant financial relationships.
Martha Arevalo-Mora indicated no relevant financial relationships.
Andrea Anderloni indicated no relevant financial relationships.
Francesco Minini indicated no relevant financial relationships.
Carmine Gentile indicated no relevant financial relationships.
Federica Calabrese indicated no relevant financial relationships.
Luca De Luca indicated no relevant financial relationships.
Anthony Teoh indicated no relevant financial relationships.
Jorge Vargas-Madrigal indicated no relevant financial relationships.
Camilla Gallo indicated no relevant financial relationships.
Edoardo Forti indicated no relevant financial relationships.
Massimiliano Mutignani indicated no relevant financial relationships.
Michiel Bronswijk indicated no relevant financial relationships.
Schalk Van der Merwe indicated no relevant financial relationships.
Helga Bertan indicated no relevant financial relationships.
Giovanni Aragona indicated no relevant financial relationships.
Edoardo Troncone indicated no relevant financial relationships.
Sundeep Lakhtakia indicated no relevant financial relationships.
Stefano Crinò indicated no relevant financial relationships.
Cesare Hassan indicated no relevant financial relationships.
Antonio Facciorusso indicated no relevant financial relationships.

Daryl Ramai, MD, MPH, MSc¹, Benedetto Mangiavillano, MD², Francesco Auriemma, MD², Danilo Paduano, MD², Alessandro Fugazza, MD³, Gianluca Franchellucci, MD³, Alessandro Repici, MD³, Marco Spadaccini, MD⁴, Carmelo Barbera, MD⁵, Vanella Giuseppe, MD⁶, Germana De Nucci, MD⁷, Andrew Fuller, MD⁸, Christopher Ko, MD⁹, John Morris, MD⁹, Belén Martínez-Moreno, MD¹⁰, Roberto Di Mitri, MD¹¹, Serena Stigliano, MD¹², Francesco Di Matteo, MD¹³, Alberto Larghi, MD¹⁴, Carlos Robles Medranda, MD¹⁵, Martha Arevalo-Mora, MD¹⁶, Andrea Anderloni, MD¹⁷, Francesco Minini, MD¹⁸, Carmine Gentile, MD¹⁸, Federica Calabrese, MD¹⁸, Luca De Luca, MD¹⁹, Anthony Teoh, MD²⁰, Jorge Vargas-Madrigal, MD²¹, Camilla Gallo, MD²², Edoardo Forti, MD²³, Massimiliano Mutignani, MD²⁴, Michiel Bronswijk, MD²⁵, Schalk Van der Merwe, MD²⁶, Helga Bertan, MD²⁷, Giovanni Aragona, MD²⁸, Edoardo Troncone, MD²⁹, Sundeep Lakhtakia, MD³⁰, Stefano Crinò, MD³¹, Cesare Hassan, MD³², Antonio Facciorusso, MD, PhD³³. P3529 - Effectiveness and Safety of EUS-Guided Gallbladder Drainage vs EUS-Guided Bile Duct Drainage in Patients With Malignant Biliary Obstruction After Failed ERCP: A Propensity-Score Matched International Multicenter Study, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.