Endoscopic Ultrasound-Guided Gallbladder Drainage Using a Lumen-Apposing Metal Stent for Acute Cholecystitis: A...

Area of Science:

• Gastroenterology
• Minimally Invasive Surgery
• Interventional Endoscopy

Background:

• Surgery is the standard for acute cholecystitis, but high-risk patients require alternative treatments.
• Percutaneous transhepatic gallbladder drainage (PT-GBD) and endoscopic transpapillary cystic duct stenting (ET-CDS) have limitations.
• Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) offers a less invasive approach.

Purpose of the Study:

• To evaluate the safety and efficacy of EUS-GBD using lumen-apposing metal stents (LAMS) for acute cholecystitis.
• To compare EUS-GBD outcomes with other drainage methods.
• To assess factors influencing EUS-GBD success and complications.

Main Methods:

• Retrospective analysis of 189 patients undergoing EUS-GBD with LAMS insertion.
• Evaluation of technical and clinical success rates.
• Assessment of complication rates including recurrent cholecystitis, bleeding, and stent migration.
• Comparison of cautery-enhanced vs. non-cautery enhanced LAMS deployment times.

Main Results:

• High composite technical success rate of 95.2% (96.8% with additional SEMS).
• High composite clinical success rate of 96.7%.
• Low rates of recurrent cholecystitis (5.1%), gastrointestinal bleeding (2.6%), and stent migration (1.1%).
• Cautery-enhanced LAMS significantly reduced deployment time.

Conclusions:

• EUS-GBD with LAMS is a safe and highly effective treatment for acute cholecystitis in high-risk patients.
• EUS-GBD offers advantages over PT-GBD in terms of postoperative pain, hospitalization, and antibiotic use.
• Prophylactic stenting through LAMS can prevent re-interventions.