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Endoscopic Ultrasound-Guided Gallbladder Drainage in Patients at High Surgical Risk With Acute Cholecystitis and
Sébastien Godat1, Marie Philippart1, Basile Keshavjee1
1Division of Gastroenterology and Hepatology, CHUV, Lausanne, Switzerland.
Insights
Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is effective for acute cholecystitis with gallbladder perforation in high-risk patients. This minimally invasive procedure demonstrated high success rates and a low adverse event profile.
Area of Science:
- Gastroenterology
- Minimally Invasive Procedures
- Interventional Endoscopy
Background:
- Acute cholecystitis with gallbladder perforation is a severe complication.
- Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is recommended for high-risk surgical patients.
- Gallbladder perforation is often a contraindication for endoscopic intervention.
Purpose of the Study:
- To evaluate the feasibility and efficacy of EUS-GBD in patients with perforated cholecystitis.
- To assess technical success, clinical outcomes, and adverse events associated with EUS-GBD in this specific patient group.
Main Methods:
- Retrospective analysis of high surgical risk patients with acute cholecystitis and gallbladder perforation.
- EUS-GBD performed using electrocautery-enhanced lumen-apposing metal stents (LAMS).
- Evaluation of technical and clinical success, and adverse events.
Main Results:
- 12 patients with a median Charlson Comorbidity Index of 7 underwent EUS-GBD.
- 100% technical success and 91.7% clinical success with significant infection improvement.
- A single adverse event (pneumoperitoneum) occurred, managed conservatively; one patient required stent revision.
Conclusions:
- EUS-GBD is a technically feasible and effective treatment for acute cholecystitis with gallbladder perforation.
- The procedure demonstrates a low adverse event rate in this high-risk population.
- Further research is warranted to validate these findings and establish long-term outcomes.
Background And Aims:
Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is the recommended treatment for high surgical risk patients with acute cholecystitis requiring drainage. Gallbladder perforation is a severe complication and is often considered a contraindication for endoscopic treatment. We report our experience with EUS-GBD in patients with perforated cholecystitis.
Methods:
This retrospective study analyzed consecutive cases of high surgical risk patients with acute cholecystitis and gallbladder perforation treated with EUS-GBD at a tertiary referral center from September 2020 to October 2023. EUS-GBD was performed using electrocautery-enhanced lumen-apposing metal stents (LAMS). Primary outcomes were technical and clinical success. Adverse events (AEs) were considered secondary endpoints.
Results:
Twelve patients (50% women, mean age 75.9 ± 15.2 years) were included. The median Charlson Comorbidity Index was 7. Reasons for EUS-GBD included age/comorbidities (33.3%), advanced malignancy (33.3%), and coagulopathy/dual antiplatelet therapy (33.3%). Technical success was achieved in all patients (100%), and clinical success was observed in 11/12 (91.7%), with significant improvement in localized and systemic infection. AEs occurred in one patient (8.33%) with pneumoperitoneum treated conservatively. The same patient experienced recurrent cholecystitis that required endoscopic stent revision 7 days after the initial procedure. Median follow-up was 173 days (range 4-820 days).
Conclusion:
EUS-GBD is both technically feasible and effective for patients with acute cholecystitis and gallbladder perforation. While the AEs rate appears low, further studies are needed to confirm these findings.
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