Endoscopic ultrasound-guided gallbladder drainage for treating symptomatic cholelithiasis in nonoperative candidates...

EUS-guided gallbladder drainage (EUS-GBD) has been found to be a safe and effective treatment option for patients with cholecystitis. There are limited data regarding the use of EUS-GBD in patients with symptomatic cholelithiasis without cholecystitis. Therefore, the aim of this study was to examine the safety and efficacy of EUS-GBD for the management of gallstones in nonoperative candidates without cholecystitis.

This 2-center retrospective study examined patients with symptomatic cholelithiasis without cholecystitis treated with EUS-GBD via lumen-apposing metal stent (LAMS) placement who were deemed nonsurgical candidates. The primary outcome was complete gallstone clearance, and secondary outcomes included clinical success, technical success of LAMS placement, and adverse events.

A total of 23 patients received EUS-GBD for symptomatic cholelithiasis in the absence of cholecystitis. LAMSs were successfully placed in all patients (technical success rate, 100%). Lithotripsy was performed in 9% of patients, and complete stone clearance was achieved in 100% of patients (87% achieved clearance within 1 treatment). Sixteen (70%) patients underwent follow-up endoscopy, during which 1 patient was noted to have small residual diminutive stones on cholecystoscopy via the LAMS. Interval imaging in all patients who did not undergo follow-up endoscopy revealed stone clearance and decompression of the gallbladder. There were no procedure-related adverse events noted, and no recurrence of symptoms was reported over a mean follow-up period of 9 months.

This 2-center case series provides preliminary evidence that EUS-GBD may offer a safe and effective method for treating symptomatic cholelithiasis without cholecystitis in nonoperative candidates.