P2327 - Bedside Endoscopic Ultrasound Guided Gallbladder Drainage in a Critically Ill Patient with Acute Cholecystitis

Raj Jessica Thomas, DO¹, Arjun Chatterjee, MD², Amandeep Singh, MD², Mohannad Abousaleh, MD³, Prabhleen Chahal, MD^2
1Cleveland Clinic Akron General, Akron, OH; ²Cleveland Clinic Foundation, Cleveland, OH; ³Huron Gastro - Trinity Health, Ann Arbor, MI

Introduction: Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is employed as a therapeutic option for high surgical risk patients suffering from acute cholecystitis and symptomatic cholelithiasis. EUS-GBD has gained traction as the preferred treatment modality in these patients given increased efficacy and minimal adverse events. This case series aims to highlight the technical feasibility and safety of bedside EUS-GBD in patients deemed too high-risk for transfer to the traditional endoscopy or operating room for EUS-GBD.

Case Description/Methods: Case 1: 72-year-old male presented with right upper quadrant pain and septic shock. Magnetic resonance cholangiopancreatography was notable for cholelithiasis with a distended GB causing hepatic duct compression, necessitating biliary drain placement. Due to patient’s ongoing shock and need for vasopressor support, procedure was performed urgently at bedside.

Case 2: 73-year-old male with a history of prior aortic dissection presented with an enlarging pseudoaneurysm following thoracic endovascular aortic repair. His hospital course was further complicated by coagulopathy and hemorrhagic shock requiring extracorporeal membrane oxygenation (ECMO) with clinical and imaging findings of cholecystitis. Given the presence of ECMO at this critical stage, a bedside EUS-GBD was performed.

Case 3: 33-year-old female presented with septic shock attributed to pneumonia with plausible precipitant as acute cholecystitis. Computed tomography showed persistent GB wall thickening and elevated liver function tests. Due to the patient's need for invasive mechanical ventilation and ongoing shock, EUS-GBD was carried out at the bedside.

Discussion: EUS-GBD for acute cholecystitis is typically reserved for high surgical risk patients. In rare circumstances, as exemplified in the aforementioned cases, where patients can be too sick to be transferred to the endoscopy or operating room for performance of EUS-GBD, bedside EUS-GBD can serve as a feasible alternative method when performed by experienced endoscopists at specialized centers.



Disclosures:


Raj Jessica Thomas, DO¹, Arjun Chatterjee, MD², Amandeep Singh, MD², Mohannad Abousaleh, MD³, Prabhleen Chahal, MD². P2327 - Bedside Endoscopic Ultrasound Guided Gallbladder Drainage in a Critically Ill Patient with Acute Cholecystitis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.