EUS-GBD for PTGBD conversion in the treatment of acute cholecystitis: patient selection is essential

Aims Percutaneous transhepatic gallbladder drainage (PTGBD) is the treatment of choice in surgically unfit patients presenting with acute cholecystitis. However, PTGBD removal after symptom resolution frequently results in recurrence. This study aims to investigate the feasibility of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using lumen-apposing metal stents (LAMS) for conversion of PTGBD in a real-life clinical setting.

Methods This is a multi-center retrospective study which reviewed all consecutive patients with acute cholecystitis who underwent PTGBD and were confirmed unfit for cholecystectomy even after symptom resolution, in which EUS-GBD was then attempted. Evaluated outcomes include technical success, clinical success (defined as resulting in removal of PTGBD), adverse events, and stent patency.

Results Between October 2022 and November 2024, eighteen consecutive patients (age 64-97, mean 83.17) were included in two Italian centers. EUS-GBD attempt was performed 3-180 days after PTGBD (mean 54.94). Technical and clinical success were achieved in fourteen patients (78%) without adverse events. LAMS size was 10x10 mm in nine cases, 15x10 mm in four cases and 20x10 mm in one case; in eleven cases a coaxial double pigtail stent was placed. Stent patency is 13-1022 days (mean 325); no patients experienced stent obstruction. In four patients EUS-GBD failed for the following reasons: in one case LAMS placement resulted in misdeployment of the distal flange in the gallbladder wall with subsequent perforation and biliary peritonitis that required surgical intervention; one patient developed a spontaneous cholecystoduodenal fistula; two patients displayed a contracted gallbladder in which LAMS placement was deemed unfeasible.

Conclusions In a real-life setting, conversion from PTGBD to EUS-GBD after acute cholecystitis resolution is a feasible technique that requires a thorough patient selection in order to avoid technical failure and adverse events.

Publication History

Article published online:
27 March 2025