EUS guided gallbladder drainage

Area of Science:

• Gastroenterology
• Interventional Endoscopy
• Minimally Invasive Surgery

Background:

• Cholecystectomy is standard for acute cholecystitis but risky for patients with comorbidities.
• Percutaneous and endoscopic transpapillary drainage have limitations.
• Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is emerging as a superior alternative.

Purpose of the Study:

• To review the efficacy and safety of EUS-GBD for acute cholecystitis.
• To discuss technical considerations and evolving accessories for EUS-GBD.
• To compare EUS-GBD with other drainage modalities.

Main Methods:

• Systematic review of published case series on EUS-GBD.
• Analysis of technical success, clinical outcomes, and adverse events.
• Evaluation of novel stent technology, including lumen-apposing metal stents (LAMS).

Main Results:

• EUS-GBD demonstrates a high overall clinical success rate of approximately 97%.
• Pneumoperitoneum is the most common complication, with advancements in self-expanding LAMS showing promise.
• EUS-GBD is effective as definitive treatment or a bridge to cholecystectomy.

Conclusions:

• EUS-GBD is a highly effective and safe minimally invasive treatment for acute cholecystitis in patients unsuitable for surgery.
• Patient anatomy and procedural details, such as access site and stent selection, are crucial for optimal outcomes.
• Continued evolution of EUS-GBD techniques and devices will further enhance its application and success rates.