A233 CANADIAN EXPERIENCE OF ENDOSCOPIC ULTRASOUND-GUIDED GALLBLADDER DRAINAGE: A CASE SERIES
Bibliographic record
Abstract
Abstract Background Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is an emerging treatment for acute cholecystitis in patients who are poor surgical candidates. There is a lack of EUS-GBD data in the Canadian setting, which may differ from its global counterparts in pattern of healthcare availability, aging population, and use of conscious sedation. Aims To describe outcomes following EUS-GBD in the Canadian setting. Methods The case series included patients undergoing EUS-GBD by an interventional gastrointestinal endoscopist in a tertiary academic centre in Canada. Data included were clinicodemographic information, procedural details, and clinical outcomes. Results From September 2023 to September 2024, a total of 18 patients underwent EUS-GBD. Median age was 85 (IQR 75-88) years, 6 (33%) were female, and 17 (94%) were American Society of Anesthesiologists Physical Status (ASA) classification III. Indication included 15 cases of acute calculous cholecystitis and 3 (17%) cases of salvage treatment for malignant biliary obstruction without alternative access. Placement was transduodenal in 10 (56%) and transgastric in 8 (44%). A coaxial double pigtail was placed in 15 cases (83%). Conscious sedation was used for 15 cases (83%), with 1 case using deep sedation with propofol and 2 with general anesthesia. All cases were technically successful followed by improvement of symptoms and biochemistry. There were no intra-procedural complications, but 3 post-procedural complications were noted. One patient had recurrent cholecystitis after 1 month due to stent occlusion despite coaxial pigtail placement, which was managed endoscopically with symptom resolution. Another patient had a buried stent, which was managed with placement of a second lumen-apposing metal stent within the first stent. A third patient had pain post-procedure suspected due to stent expansion, which self-resolved within 2 weeks. No rescue percutaneous or surgical interventions were required following EUS-GBD. No patients underwent subsequent cholecystectomy. Four patients died from underlying systemic disease, including 3 patients who underwent EUS-GBD for malignant obstruction with no recurrent cholecystitis up to time of death at 15-150 days post-procedure. Conclusions In an elderly population and using primarily conscious sedation, EUS-GBD was safe and effective in patients with high surgical risk, underscoring the suitability of this technique for a Canadian setting. A. Gallbladder with debris/sludge on EUS. B. Distal flange of lumen apposing metal stent (LAMS) deployed within gallbladder lumen. C. Proximal flange deployed in duodenum. D. Coaxial double pigtail placed within LAMS. Funding Agencies None
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.004 |
| Science and technology studies | 0.005 | 0.002 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".