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OUTCOMES OF EUS-GUIDED GALLBLADDER DRAINAGE IN ACUTE CHOLECYSTITIS WITH CONTAINED PERFORATION: A PROSPECTIVE COHORT

Giuseppe Vanella 1, Lucía Guilabert 2, Francesco Frigo 3, Rosa Claudia Stasio 3, Roberto Leone 4, Matteo Tacelli 1, Nicole Liscia 5, Luigi Leta 5, Nicolò Pecorelli 4, Giulio Belfiori 5, Michele Reni 4, Massimo Falconi 1, Gabriele Capurso 1, Paolo Giorgio Arcidiacono 1

Affiliations

1 IRCCS San Raffaele Institute, Milan, Italy|||Vita-Salute San Raffaele University, Milan, Italy

2 Dr. Balmis General University Hospital from Alicante, Alicante, Spain

3 IRCCS San Raffaele Institute, Milan, Italy|||University of Turin, Turin, Italy

4 Vita-Salute San Raffaele University, Milan, Italy|||IRCCS San Raffaele Institute, Milan, Italy

5 IRCCS San Raffaele Institute, Milan, Italy

Summary

AI Generated

A prospective series of 19 patients with acute cholecystitis and contained perforation treated with EUS-guided gallbladder drainage using lumen apposing metal stents achieved 100% technical success and 94.7% clinical success with no recurrence during median 254-day follow-up.

Among 48 EUS-GBD procedures performed between 2020 and 2024, 19 patients presented with contained perforation, a condition typically considered a contraindication to EUS-GBD.
Acute cholecystitis was iatrogenic in 79% of cases, most commonly following ERCP with metal stenting, and 89.5% of patients had underlying malignancy with pancreatic adenocarcinoma being most frequent.
Technical success was 100% and clinical success 94.7%, with statistically significant 7-day reductions in white blood cells (p=0.0017) and C-reactive protein (p=0.0067).
Adverse events occurred in 21% of cases with 11% severe or fatal; notably, 2 adverse events including 1 fatal event were related to attempts at draining adjacent liver abscesses.
No acute cholecystitis recurrence occurred during median follow-up of 254 days, and median time to chemotherapy for oncology candidates was 26 days.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

EUS-guided Gallbladder Drainage (EUS-GBD) with Lumen Apposing Metal Stent (LAMS) is a standard treatment for management of acute cholecystitis (AC) in unfit-for-surgery patients. Gallbladder Perforation is standardly considered as a contraindication to EUS-GBD.

Aims & Methods

This series aims at exploring outcomes of EUS-GBD in patients with AC and contained perforation (cp-AC).
All consecutive patients undergoing EUS-GBD in a single tertiary institution between 2020 and 2024 were enrolled in a prospective registry (PROTECT, ClinicalTrials.gov NCT04813055). Patients with cp-AC were included in this series, when presenting gallbladder wall rupture with adjacent encapsulated fluid collections. Baseline demographics and technical details were registered together with Technical success, Clinical success, Adverse Events (AEs), Recurrence and Survival evaluated every 60 days.

Results

From a prospective cohort of 48 EUS-GBD, 19 patients presented with cp-AC (median age 71 [62-78], male 42.1%, Charlson Comorbidity Index of 8 [7-9.8]). Acute cholecystitis was iatrogenic in 79% of these cases (ERCP with metal stenting in 14 and TACE in 1). Reason to avoid surgery was underlying malignancy in 89.5% and comorbidities in 15.8%. Amongst underlying malignancies, the most frequent one was Pancreatic Adenocarcinoma.
Ascites was present in 26.3% of cases. All procedures were performed transduodenally, with an operative luminal space of 31 [25 – 36] mm and a median tract thickness of 6 [5-8] mm.
A 10 mm Hot Axios LAMS was used in 95% of cases, and the release was free-hand in 89% and over-the-wire after former distention in 11% of cases. Antibiotic prophylaxis and coaxial double-pigtail plastic stents were adopted in 95% of cases.
Technical success was 100%. Clinical success was 94.7%, with a statistically significant 7-days reduction of white blood cells (p=0.0017 ) and C Reactive Protein (p=0.0067) .
AEs were registered in 21% of cases, severe/fatal in 11%.
Of note, 2 AEs (1 fatal) were related to additional attempts of draining liver abscesses adjacent to the GBD.
Five patients (27%) underwent additional endoscopic procedures for peroral cholecystoscopy, GBD clearance and LAMS removal, while 2 (11%) patients experienced uneventful LAMS migration.
Median hospital stay was 8 [6-13] days and median time to chemotherapy was 26 [19-56] days for those who were candidate to oncological treatment (N=10).
After a median follow-up of 254 [56-454] days, no AC recurrence was registered.

Conclusion

In the context of AC, contained perforation with adjacent collections does not seem to represent a contraindication to EUS-GBD with LAMS, despite the additional complexity related to a thicker interluminal distance. Management of large adjacent abscesses should involve multidisciplinary management and might require percutaneous drainage.

Conference

UEG Week Berlin 2025

Topics

Hepatobiliary

Submission format

Abstract

Session

Therapeutic EUS (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Biliary stones: Diagnostic algorithm and timing

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