EUS-guided cholecystenterostomy: a new technique (with videos)

Area of Science:

• Gastroenterology
• Minimally Invasive Surgery
• Endoscopic Ultrasound

Background:

• Cholecystectomy is the standard treatment for acute cholecystitis.
• Some patients are not candidates for surgery.
• Endoscopic ultrasound (EUS)-guided transduodenal gallbladder drainage presents a minimally invasive option.

Purpose of the Study:

• To introduce and evaluate a novel technique: EUS-guided cholecystenterostomy.
• To assess the feasibility and outcomes of this new procedure.

Main Methods:

• A retrospective case series involving three patients with severe acute cholecystitis.
• Patients were unresponsive to conservative treatment and unfit for cholecystectomy.
• The procedure involved EUS and fluoroscopic guidance for needle puncture, guidewire insertion, cystoenterostome passage, and stent placement.

Main Results:

• Successful cholecystenterostomy was achieved in all three patients.
• Patients showed rapid clinical improvement and normalization of inflammatory markers.
• One patient experienced a minor bile leak, which resolved without significant consequences. No recurrence of cholecystitis was observed.

Conclusions:

• EUS-guided cholecystenteric drainage is a technically feasible, safe, and effective procedure.
• It enables gallbladder drainage and resolution of sepsis in patients with acute cholecystitis who cannot undergo surgery.
• This technique provides a valuable alternative for high-risk surgical candidates.