Background and study aim: Endoscopic ultrasonography-guided transmural gallbladder drainage (EUS-GBD) has been
proposed for the management of acute cholecystitis in high risk patients; however,
little is known about the long-term outcomes of this treatment. The aim of this study
was to evaluate the procedural and long-term outcomes of EUS-GBD with self-expandable
metallic stent (SEMS).
Patients and methods: Data for this retrospective study were obtained from a prospectively collected EUS
database. Patients with acute cholecystitis who were deemed unsuitable for cholecystectomy
were included. Study outcomes were technical and clinical success, adverse events,
and stent patency.
Results: EUS-GBD was technically and clinically successful in 62/63 patients (98.4 %; 95 %
confidence interval [CI] 94.9 % – 100 %). Procedural adverse events included duodenal
perforation (n = 1, 1.6 %) and self-limiting pneumoperitoneum (n = 2, 3.2 %), all
of which resolved with conservative treatment. Long-term outcomes of EUS-GBD were
evaluated in 56 patients who were followed for a median of 275 days (range 40 – 1185
days). Late adverse events developed in four patients (7.1 %; 95 %CI 5.7 % – 8.4 %),
including asymptomatic distal stent migration (n = 2), and acute cholecystitis due
to stent occlusion (n = 2). Two patients with occluded stent were successfully treated
endoscopically (reintervention rate of 3.6 %). A total of 54 patients (96.4 %) had
no recurrence of acute cholecystitis during follow-up. Median stent patency time was
190 days overall (range 15 – 1185 days) and 458 days (range 151 – 1185 days) for the
28 patients who were alive at the study end. The cumulative stent patency rate was
86 % at 3 years.
Conclusions: EUS-GBD with an SEMS for acute cholecystitis showed excellent long-term outcomes
and may be a definitive treatment in patients who are unsuitable for cholecystectomy
because of advanced malignancy or high surgical risk.
