Elective endoscopic treatment of benign gallbladder diseases in high-surgical risk patients: a retrospective study

EUS-guided gallbladder drainage (EUS-GBD) has proved to be highly safe and effective in patients with acute cholecystitis at high surgical risk. These findings stimulated the search for populations outside the acute setting, where EUS-GBD performed electively could become a valid therapeutic option.

This is a retrospective, multicenter, study involving patients who underwent elective endoscopic gallbladder treatment (EEGBT) in nine referral centers. All patients had a benign gallbladder disease and were judged to be at high surgical risk, with an indication to undergo cholecystectomy. EUS-GBD was performed using LAMSs and followed by intra-gallbladder lithotripsy when necessary. Primary outcome was adverse events (AE) rate; secondary outcomes included technical and clinical success rates and need for additional intracholecystic procedures.

Forty-nine patients (mean age 78.7 ± 12.3 years, M/F 22/27) underwent EEGBT over a 2-year period. All patients had ASA score ≥ 3, and a Charlson Comorbidity Index ≥ 5 was present in 71% of them. The most frequent indication was recurrent mild acute cholecystitis (42.9%). Technical success was achieved in all patients, with LAMS implantation more frequently performed from the duodenum (67.3%). AEs occurred in 3/49 (6.1%) and included 2 cases of stent occlusion-related cholecystitis, and one case of cholangitis all successfully treated endoscopically. One patient was lost at follow-up after the procedure. Intracholecystic lithotripsy was required in 12.5% of patients (6/48). Clinical success was obtained in 100% of cases. There were no EEGBT-related deaths.

EEGBT has high technical and clinical success rates, with an acceptable safety profile. Prospective studies to standardize procedural aspects and develop dedicated accessories for this procedure are needed.