Commentary

Endoscopic ultrasound (EUS)-guided drainage has been suggested as the treatment of choice for acute cholecystitis in high risk surgical patients, offering improved outcomes that include fewer re-interventions [1]. Gangrenous cholecystitis is a severe form of cholecystitis typically treated by surgery [2].

In this E-Video, Orlandini et al. report on a case where acute cholecystitis as yet unrecognized as gangrenous was successfully treated by EUS-guided drainage using a 10 × 10-mm lumen-apposing metal stent (LAMS). However, re-intervention was needed 3 weeks later because of stent occlusion by necrotic tissue. The presence of the LAMS allowed for complete endoscopic clearance and long-term recovery.

EUS-guided gallbladder drainage may allow treatment also of gangrenous cholecystitis including subsequent necrosectomy. To avoid the need for re-intervention, the use of larger-caliber stents or coaxial placement of a double-pigtail plastic stent within the metal stent may be considered in these patients [3].

Publication History

Article published online:
28 February 2023

• References

• 1 Teoh AYB, Kitano M, Itoi T. et al. Endosonography-guided gallbladder drainage versus percutaneous cholecystotomy in very high-risk surgical patients with acute cholecystitis: an international randomized multicenter controlled superiority trial (DRAC 1). Gut 2020; 69: 1085-1091
• 2 Nikfarjam M, Niumsawatt V, Sethu A. et al. Outcomes of contemporary management of gangrenous and non-gangrenous acute cholecystitis. HPB (Oxford) 2011; 13: 551-558
• 3 James TW, Baron TH. EUS-guided gallbladder drainage: A review of current practices and procedures. Endosc Ultrasound 2019; 8: S28-S34