Management and outcomes of antithrombotic therapy in EUS-guided gallbladder drainage

• Published in: Gastrointestinal endoscopy 2025-01, Vol.101 (1), p.123-128
• Main Authors: Makar, Michael, Yodice, Michael, Still, Matt, Udoeyo, Idorenyin F., Diehl, David L., Khara, Harshit S., Confer, Bradley D.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Drainage - methods; Endosonography; Female; Fibrinolytic Agents - administration & dosage; Fibrinolytic Agents - therapeutic use; Gallbladder Diseases; Humans; Length of Stay - statistics & numerical data; Male; Middle Aged; Platelet Aggregation Inhibitors - administration & dosage; Platelet Aggregation Inhibitors - therapeutic use; Retrospective Studies; Thrombosis - etiology; Ultrasonography, Interventional
• ISSN: 0016-5107; 1097-6779; 1097-6779
• DOI: 10.1016/j.gie.2024.08.003

EUS-guided gallbladder drainage (EUS-GBD) is increasingly used for the management of gallbladder disease in patients at high risk for cholecystectomy. These patients often have underlying medical comorbidities requiring anticoagulation and/or antiplatelet therapy. We evaluated the safety, management, and outcomes of EUS-GBD in patients being treated with antithrombotic therapy (ATT). We performed a retrospective study of patients undergoing EUS-GBD between 2018 and 2023 within Geisinger Health System. Outcomes were analyzed between patients previously on ATT but held for the procedure compared with no ATT. Primary outcomes were bleeding within 48 hours and 30 days. Secondary outcomes were risk of thrombotic events, length of stay, and 30-day mortality. Of 177 patients undergoing EUS-GBD, 118 patients were on ATT. No statistical difference was found for EUS-GBD–related bleeding for patients on ATT compared with no ATT within 48 hours (.9% vs 0%, P > .999) or within 30 days (3.5% vs 0%, P = .302). Overall, 5 patients (2.9%) had bleeding related to the EUS-GBD procedure. There was no difference between the groups for secondary outcomes: thrombotic events (2.5% vs 3.4%), length of stay (7 days vs 5 days), and 30-day mortality (11% vs 10.2%). Patients undergoing EUS-GBD who require ATT did not have any immediate or delayed increased risk of bleeding, thrombotic events, length of stay, or mortality when the medication was appropriately held.