Introduction
Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has emerged as a minimally invasive alternative to percutaneous drainage for high-risk surgical patients with acute cholecystitis. Although EUS-GBD is gaining traction in clinical practice, real-world data in complex and high-risk patients remain scarce, particularly regarding outcomes in perforated or malignant cases. While its efficacy is increasingly recognized, data on predictors of success and complications remain limited.
Aims & Methods
This retrospective study explored potential clinical and procedural factors associated with outcomes following EUS-GBD. Patients undergoing EUS-GBD for acute cholecystitis between October 2021 and January 2024 at a tertiary center were included. All procedures were performed by endoscopists with advanced training in interventional EUS. Data on demographics, comorbidities, procedural details, and outcomes were collected. Clinical success was defined as resolution of sepsis or cholecystitis symptoms within 48 hours. Complications included bile leak, infection, and the need for reintervention. Due to the limited sample size, statistical analysis was descriptive and exploratory.
Results
Thirteen patients (6 females, median age 69.1 years [IQR 45–90]) underwent EUS-GBD during the study period. Indications included gallstones (53.8%), malignant cystic duct obstruction (38.4%), and ischemia (7.7%). Reasons for non-surgical management included terminal malignancy (n=6, 46.2%), coronary artery disease (n=5, 38.5%), cirrhosis with hepatocellular carcinoma (n=1, 7.7%), and the patient’s choice (n=1, 7.7%). Lumen-apposing metal stents (LAMS) were placed transgastrically in 10 patients (n=10, 77%) and transduodenally in 3 (n=3, 23%).
Two patients (15.4%) presented with gallbladder perforation and pericholecystic abscess at the time of EUS-GBD. Both cases achieved full resolution following the drainage procedure, indicating that EUS-GBD may serve as a valuable rescue therapy in complicated acute cholecystitis.
Clinical success was achieved in 12 out of 13 patients (92.3%). One patient (7.7%) developed a bile leak, associated with the presence of ascites and hepatocellular carcinoma. Median post-procedural hospital stay was 6.8 days (IQR 3–20). Exploratory analysis suggested a trend toward higher complication rates in patients with ascites and those undergoing transgastric drainage, though no definitive conclusions could be drawn. At 30-day follow-up, no late adverse events or stent-related complications were reported.
Conclusion
EUS-GBD is a highly effective and safe treatment option for acute cholecystitis in patients unfit for surgery, with rapid symptom resolution and acceptable hospital stay duration. Notably, the resolution of pericholecystic abscesses in two cases of gallbladder perforation suggests that EUS-GBD may be beneficial even in more complex clinical scenarios. Preliminary data from this small cohort suggest that the presence of ascites and transgastric access may increase the risk of adverse events. These findings support the role of EUS-GBD not only as a safe alternative in high-risk patients but also as a potentially definitive solution in anatomically and clinically challenging cases. Further prospective studies with more significant patient populations are warranted to validate these early observations and optimize outcomes in this vulnerable population.