P2315 - Dual Biliary Decompression: Endoscopic Ultrasound-Guided Gallbladder Drainage With Common Bile Duct Stenting in Malignant Biliary Obstruction and Acute Cholecystitis

Shyamal Sheth, DO¹, Rahil Desai, DO², Mohammed A. Khan, MS, DO¹, Mishaal Khan, MD³, Rida Khan, BS⁴, Lujain Khan, BA⁵, Faizan Khan, MD⁶, Zohair Ahmed, MD^7
1Franciscan Health Olympia Fields, Chicago, IL; ²Franciscan Health Olympia Fields, Westlake, OH; ³Garden City Hospital, Garden City, MI; ⁴Michigan State University College of Human Medicine, East Lansing, MI; ⁵Augustana University, Sioux Falls, SD; ⁶Franciscan Health Olympia Fields, Olympia Fields, IL; ⁷Franciscan Health Munster Hospital, Munster, IN

Introduction: Pancreatic Adenocarcinoma is the second most prevalent GI malignancy in the United States. Nearly 70% of patients exhibit biliary tract obstruction at diagnosis, necessitating biliary drainage through endoscopic retrograde cholangiopancreatography (ERCP). Acute cholecystitis, a common complication of malignant biliary obstruction, is usually managed surgically. However, for poor surgical candidates, EUS-guided gallbladder drainage (EUS-GBD) is an alternative. Here, we present a case of a patient with both complications requiring biliary decompression techniques in a single endoscopic session.

Case Description/Methods: A 52-year-old female presented with diffuse abdominal pain lasting one month. Imaging studies revealed a likely pancreatic neoplasm with biliary and pancreatic ductal dilation, elevated CEA, and alkaline phosphatase levels. Further evaluation confirmed metastatic adenocarcinoma originating from the pancreas. Additionally, acute cholecystitis and suspected malignant biliary strictures were present. Due to being a poor surgical candidate, a dual biliary intervention was planned. Initially, an ERCP with placement of an uncovered metal stent in the CBD was performed. During the EUS, a dilated gallbladder body of 40 mm was noted, and successful cholecystoduodenostomy was achieved using an Axios stent. A final pigtail stent was placed through the Axios stent to maintain patency given the immediate significant drainage through the Axios stent. Subsequently, patient made a full recovery and was discharged home with an outpatient follow-up.

Discussion: EUS-GBD is an effective treatment option for acute cholecystitis and symptomatic cholelithiasis in patients with malignant biliary obstruction unsuitable for surgery. Recent advancements have made EUS-GBD a viable alternative to percutaneous cholecystostomy, offering the advantage of a completely internal draining system. It can be used as a primary or secondary intervention, with luminal apposing stents being the preferred choice. The Axios stent system presents notable advantages over percutaneous stent systems in the context of ERCP. These advantages encompass its minimally invasive nature and endoscopic placement, procedural convenience by obviating the need for separate interventions, demonstrated efficacy in biliary drainage, and reduced risk of infection associated with percutaneous access. Collectively, the Axios stent system represents a superior alternative for accomplishing biliary decompression during ERCP procedures.



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Shyamal Sheth, DO¹, Rahil Desai, DO², Mohammed A. Khan, MS, DO¹, Mishaal Khan, MD³, Rida Khan, BS⁴, Lujain Khan, BA⁵, Faizan Khan, MD⁶, Zohair Ahmed, MD⁷. P2315 - Dual Biliary Decompression: Endoscopic Ultrasound-Guided Gallbladder Drainage With Common Bile Duct Stenting in Malignant Biliary Obstruction and Acute Cholecystitis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.