EUS-Guided Gallbladder Drainage in Acute Cholecystitis With Contained Perforation: An International Multicenter Study

Abstract

Background and Aims

Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is an established alternative for treating acute cholecystitis (AC) in poor surgical candidates. However, management of AC with contained gallbladder perforation (CGP) remains unclear, with percutaneous treatment as the treatment of choice due to safety concerns regarding EUS-GBD. This study aimed to assess the feasibility and safety of EUS-GBD with Lumen apposing metal stent (LAMS) in patients with AC complicated by CGP.

Methods

This was a retrospective, international, multicenter study across 10 tertiary referral centers. The primary outcome was safety, assessed by the occurrence of adverse events (AE), which were reported according to the AGREE classification. Secondary outcomes included clinical success, defined as resolution of symptoms with accompanying objective improvement in biochemical and/or radiologic findings of cholecystitis within 3 days of the procedure.

Results

Between 2020 and 2024, a total of 57 patients were included. AEs occurred in seven patients (12.3%), evaluated as grades II, III, and V in 2, 4, and 1 patients, respectively. The only intra-procedural AE was misdeployment of the distal flange of the LAMS, which was successfully managed endoscopically. Post-procedural AEs comprised four bleeding events, one perforation, and one liver abscess, the latter resulting in patient death. Clinical success was observed in 52 of 54 evaluable patients (96%) with a resolution of the peri-cholecystic collection documented in 94.4% of patients.

Conclusion

This study supports the feasibility and safety of EUS-GBD for the treatment of acute cholecystitis with CGP in poor surgical candidates.