Feasibility and safety of EUS-guided cholecystoenterostomy with a modified covered self-expandable metal stent for patients with acute cholecystitis, who are unsuitable for cholecystectomy

Percutaneous cholecystostomy has been conducted as the choice of treatment for high risk patients with acute cholecystitis, who are unsuitable for cholecystectomy because of high operative mortality and morbidity. Percutaneous cholecystostomy, however, has several disadvantages such as patient discomfort and catheter dislodgement as well as complications including bleeding, bile leakage, and pneumoperitoneum. Recently, endoscopic ultrasound (EUS)-guided cholecystoente-rostomy with a modified covered self-expandable metal stent (CSEMS) is being attempted as an alternative treatment for those patients.

EUS-guided cholecystoenterostomy with CSEMS was performed on eight consecutive patients with acute cholecystitis, who are unsuitable candidates for cholecystectomy. We evaluated technical success, clinical success, complications, and recurrence.

Modified CSEMSs were successfully placed in all patients through the stomach (n=7) or duodenum (n=1). Seven patients achieved functional success within 3 days after placement of a metal stent. one pneumoperitoneum and one bile peritonitis occured after procedure, but, improved with conservative management. During the period of 3 months after procedure, cholecystitis did not recur in any followed patients.

Placement of metal stent after EUS-guided cholecystoenterostomy is feasible and safe for patients with acute cholecystitis, who are unsuitable for cholecystectomy. And, metal stent may protect against bile leakage.