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Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
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Published on: March 25, 2022

EUS-Guided Gallbladder Drainage in Acute Cholecystitis With Contained Perforation: An International Multicenter Study

Marco Spadaccini1,2, Gianluca Franchellucci1, Francesco Auriemma3

  • 1Endoscopy Unit, IRCCS Humanitas Research Hospital, Milan, Italy.

Digestive Endoscopy : Official Journal of the Japan Gastroenterological Endoscopy Society
|June 30, 2026
PubMed

Insights

Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is feasible and safe for treating acute cholecystitis with contained gallbladder perforation in high-risk patients. This minimally invasive approach offers a viable alternative when surgery is not an option.

Area of Science:

  • Gastroenterology
  • Interventional Endoscopy
  • Surgical Innovation

Background:

  • Acute cholecystitis (AC) in poor surgical candidates often requires alternative management.
  • Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is an option for AC, but its use in contained gallbladder perforation (CGP) is less understood.
  • Percutaneous drainage is often preferred for AC with CGP due to perceived safety concerns with EUS-GBD.

Purpose of the Study:

  • To evaluate the feasibility and safety of EUS-GBD using Lumen-apposing metal stents (LAMS) for AC complicated by CGP.
  • To assess adverse events and clinical success rates associated with EUS-GBD in this specific patient population.

Main Methods:

  • Retrospective, international, multicenter study involving 57 patients across 10 tertiary centers.
  • Primary outcome: safety assessed by adverse events (AE) using AGREE classification.
  • Secondary outcomes: clinical success defined by symptom resolution and objective improvement within 3 days.

Main Results:

  • Adverse events occurred in 12.3% of patients (n=7), with varying severity.
  • The only intra-procedural AE was LAMS misdeployment, managed endoscopically.
  • Clinical success was high (96%), with significant resolution of peri-cholecystic collections (94.4%).

Conclusions:

  • EUS-GBD with LAMS is a feasible and safe treatment option for AC with CGP in patients unsuitable for surgery.
  • This approach provides a valuable minimally invasive alternative to traditional methods.
Abstract

Keywords:
EUS‐GBDacute cholecystitisgallbladder perforation

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