EUS-guided gallbladder drainage for acute cholecystitis in the Western world: exploring heterogeneity in current practice and the relation with patient outcome

Aims The aim of the study is to examine heterogeneity in patient profiles and treatment protocols for EUS-guided gallbladder drainage (EUS-GBD) in Western countries, and to assess the relation to patient outcome.

Methods An international multicenter retrospective cohort study at 18 institutions in Europe, the United States of America and Canada is currently conducted. All consecutive patients (> 18 years) who underwent EUS-guided gallbladder drainage with LAMS for acute cholecystitis are included. Demographic, medical, procedural and outcome data are captured in a predefined data extraction file. Adverse events (AEs) are graded following the AGREE classification (endoscopy-related AEs) and the Clavien Dindo classification (surgery-related AEs).

Results At the moment of abstract submission, only preliminary data from 4/18 centres were available for analysis. Sixty-two patients were included, with a follow-up period of 165 days (median, range 1-1241 days). The vast majority (56/62, 90.3%) of LAMS placements were performed from within the duodenum using a 10/10 or a 15/10 size (52/62; 83.9%). In the majority of cases (37/62; 59.7%), a coaxial stent (DPPS) was placed. The technical success rate of EUS-GBD was high (60/62; 96.8%). In 59/62 (95.2%) patients, clinical and biochemical improvement was observed after a median of 2 days (range: 1-10 days). Patients were discharged from the hospital after a median of 8 days (range: 1–129 days). AEs were observed in 17/62 patients (27.4%, 5 AGREE II, 8 AGREE IIIa and 1 AGREE V). Six AEs (9.7%) were related to recurrence of biliary disease, all in the patient group treated for calculous cholecystitis and with incomplete gallbladder stone clearance. Only 3 AEs (4.8%) were LAMS-related adverse events: 1 lumen occlusion by food, 1 lumen occlusion by a stone and 1 perforation with the tip of device through the contralateral gallbladder wall. Seven patients (11.3%) received EUS-GBD as bridge to future surgery. In all patients, the LAMS was removed and exchanged to double pigtails, if possible. Two patients have not yet received cholecystectomy at the time of writing. Four cholecystectomies were performed laparoscopically. One patient received laparotomy because of a need for concomitant surgical ampullectomy. Adverse events after cholecystectomy where seen in 3/5 cases (60%) but none of them could be linked to the previous EUS-GBD.

Conclusions This preliminary analysis of an ongoing international multicenter retrospective cohort study confirms that EUS-GBD is an effective treatment option for acute cholecystitis in patients that are temporally or permanently unfit for surgery, with an acceptable safety profile and a low rate of biliary disease recurrence. The completion of this large multicenter cohort study will likely provide further insights into the optimal protocol for EUS-GBD in different patient settings (eg. bridge to surgery or non-fit for future surgery, poor or better prognosis,…).

Publication History

Article published online:
27 March 2025