AB178. 109. Management of gallbladder perforations in the elderly: the first Irish use of the Hot Axios LASEMS stent

Background: Gallstone disease remains a significant source of morbidity and mortality, particularly in the extremes of age. In cases of gallbladder perforation, definitive management may be difficult in patients not fit for interval laparoscopic cholecystectomy. One option may be long-term percutaneous drainage of the biliary system, although this comes with significant morbidity and cost associated with frequent hospital visits. We report the first two Irish cases of endoscopic ultrasound (EUS)-guided cholecysto-duodenal stent placement using the hot-AXIOS system.

Methods: Two patients were selected as appropriate candidates. Patient A is an 80-year-old male with lung cancer, with a recurrent gallbladder perforation. Patient B is a 94-year-old female nursing home resident with a first presentation of a gallbladder perforation. Both patients were treated for sepsis and a percutaneous drain was initially placed to establish source control. Following improvement in sepsis, and EUS-guided LASEMS stent was placed in each patient under conscious sedation.

Results: Both procedures were uneventful. Patient A’s procedure took 40 min. His biliary drain was clamped on day 1 post-procedure and removed on day 3. Patient B’s procedure took 35 min. Her biliary drain was clamped on day 1 post-procedure and removed on day 4. There have been no morbidities to date.

Conclusions: In elderly patients unsuitable for surgical management of gallstone disease, cholecysto-duodenal stenting offers an alternative treatment approach and avoids the long-term care and complications associated with percutaneous drains.

Keywords: Hot; axios; LASEMS; stent