S1105 Practice Patterns of Endoscopists Performing Endoscopic Gallbladder Drainage

Introduction:

Over the last decade, techniques of endoscopic gallbladder drainage (EGBD) have been employed for temporary or definitive gallbladder drainage in patients with acute cholecystitis who are not surgical candidates. Despite growing interest and clinical use of EGBD, little is known about technical aspects of practice patterns of EGBD. Our aim was to survey endoscopists to evaluate the practice patterns and technical considerations regarding endoscopic gallbladder drainage.

Methods:

An 18-item survey was designed to evaluate the practice patterns of advanced endoscopists with regards to endoscopic gallbladder drainage. The survey was structured into the following domains: i) Experience and practice setting of endoscopists, ii) Preference and volumes of endoscopic drainage, iii) Practice patterns with respect to technical aspects of endoscopic gallbladder drainage. The survey was distributed to all members of the American Society for Gastrointestinal Endoscopy (ASGE). Each response was included in the final analysis. Descriptive statistics were calculated using frequencies and percentages.

Results:

Responses were received from 217 endoscopists. Of these, 178 perform EUS-GBD and 178 perform ETGBD. The number of years since graduation of advanced endoscopy fellowship was: 0-5 years (39.6%), 6-10 years (16.5%), 11-15 years (10.4%) and more than 15 years (33.5%). The majority of respondents (75.4%) practice in a tertiary care setting. The preferred approach for endoscopic gallbladder drainage was EUS-guided gallbladder drainage (EUS-GBD) in 58.8%, ERCP-guided transpapillary gallbladder drainage (ETGBD) 30.2%, and no preference in 11%. For EUS-GBD, 48% had no preference in anatomic site, 35.5% preferred transduodenal and 16.5% transgastric approaches. For EUS-GBD, 69.2% preferred placing lumen apposing metal stent (LAMS) without a guidewire. In terms of LAMS removal after EUS-GBD, 49.3% leave the LAMS indefinitely and 48.3% schedule routine removal of LAMS. For ETGBD via ERCP, the majority of respondents prefer 7 French (73.3%) and double pigtail (85.4%) stents. The most common follow-up plans after ETGBD were: never/as needed (36.7%) and every 3 months (29.5%). Further characteristics are summarized in Table.

Conclusion:

Despite growing interest in endoscopic gallbladder drainage, significant heterogeneity in practice patterns exists. Further study is needed to better understand these differences for further standardization of procedural techniques.

Table 1. -

Preferred Approach for Endoscopic Drainage in Acute Cholecystitis
Endoscopic ultrasound-guided gallbladder drainage	107 (58.8%)
ERCP-guided transpapillary gallbladder stenting	55 (30.2%)
Other	20 (11%)
Preferred enteral access point for EUS GB drainage
Transgastric	25 (16.5%)
Transduodenal	54 (35.5%)
No preference	73 (48.0%)
Preferred Stent Type (EUS-GBD)
Lumen apposing metal stent	141 (100%)
Plastic stent	0
Use of guidewire (EUS-GBD)
Placed over a guidewire	43 (30.1%)
Placed without a guidewire	99 (69.2%)
Other	1 (0.7%)
Use of plastic stents within LAMS (EUS-GBD)
Yes	82 (57.3%)
No	59 (41.3%)
Other	2 (1.4%)
Preference regarding placement of number of plastic stents within LAMS (EUS-GBD)
One	74 (75.5%)
Two	23 (23.5%)
Three	0 (0%)
More than Three	1 (1.0%)
Case-by-case basis	0 (0%)
Removal of LAMS after EUS GB drainage
Leave indefinitely	67 (49.3%)
Schedule routine removal	69 (48.3%)
EUS-guided gallbladder drainage on patients who are currently on anticoagulation
Yes	30 (21.0%)
No	113 (79.0%)
Transpapillary gallbladder drainage (ETGBD)
Preferred Stent Diameter
7 French	85 (73.3%)
10 French	21 (18.1%)
Varies	0 (0%)
Other	10 (8.6%)
Preferred Stent Type
Single pigtail	7 (5.7%)
Double pigtail	105 (85.4%)
Straight stent	3 (2.4%)
No preference	8 (6.5%)
Number of stents typically placed
A single stent	119 (82.6%)
Multiple stents	21 (14.6%)
Varies case to case	0 (0%)
Other	4 (2.8%)
Follow up after stent placement
Every 3 months	41 (29.5%)
Every 6 months	14 (10.1%)
Never	51 (36.7%)
Other	33 (23.7%)