Interventional Endoscopic Ultrasound (EUS) (on demand)-EUS-Guided Gallbladder Drainage

Video Transcription

Video Summary

Dr. Rashad Khan presented EUS-guided gallbladder drainage as rescue therapy for malignant distal biliary obstruction after failed ERCP, when choledochoduodenostomy and hepaticogastrostomy were unsuitable. In a patient with metastatic pancreatic cancer, ascites, a distended gallbladder, and a patent cystic duct, a cautery-tipped lumen-apposing metal stent (LAMS) was deployed successfully. The case highlighted the importance of allowing cautery—not force—to advance the device, maintaining endoscopic visualization, and using a LAMS to reduce the risk of leakage or migration. Panelists emphasized caution and prophylactic antibiotics when ascites is present.<br /><br />Discussion covered access route and positioning, stent follow-up, and challenging cases involving stones or percutaneous drains. Transduodenal access was often preferred when feasible, though practice varied. For patients with limited life expectancy, the LAMS may be left in place; others may return for removal and plastic stent placement. Stones can complicate deployment, and gallbladder distension should be cautious and controlled. Panelists also discussed using a guidewire as a safety measure, adding coaxial pigtail stents, and the potential value of fixation devices in high-risk cases. They stressed that clinicians should not proceed if the access window is unsuitable and should obtain specific consent for gallbladder drainage.

Asset Subtitle

Rishad Khan, MD

Meta Tag

Concept Endoscopic Ultrasound-Guided Gallbladder Drainage

Concept Lumen-Apposing Metal Stent

Concept Distal Flange

Concept Proximal Flange

Concept Patient Selection

Keywords

EUS-guided gallbladder drainage

malignant distal biliary obstruction

cautery-tipped LAMS

failed ERCP

metastatic pancreatic cancer

ascites

endoscopic stent deployment

lumen-apposing metal stent

pancreatic cancer