Endoscopic Ultrasound‐Guided Gallbladder Drainage in Patients at High Surgical Risk With Acute Cholecystitis and Gallbladder Perforation

BACKGROUND AND AIMS: Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is the recommended treatment for high surgical risk patients with acute cholecystitis requiring drainage. Gallbladder perforation is a severe complication and is often considered a contraindication for endoscopic treatment. We report our experience with EUS-GBD in patients with perforated cholecystitis. METHODS: This retrospective study analyzed consecutive cases of high surgical risk patients with acute cholecystitis and gallbladder perforation treated with EUS-GBD at a tertiary referral center from September 2020 to October 2023. EUS-GBD was performed using electrocautery-enhanced lumen-apposing metal stents (LAMS). Primary outcomes were technical and clinical success. Adverse events (AEs) were considered secondary endpoints. RESULTS: Twelve patients (50% women, mean age 75.9 ± 15.2 years) were included. The median Charlson Comorbidity Index was 7. Reasons for EUS-GBD included age/comorbidities (33.3%), advanced malignancy (33.3%), and coagulopathy/dual antiplatelet therapy (33.3%). Technical success was achieved in all patients (100%), and clinical success was observed in 11/12 (91.7%), with significant improvement in localized and systemic infection. AEs occurred in one patient (8.33%) with pneumoperitoneum treated conservatively. The same patient experienced recurrent cholecystitis that required endoscopic stent revision 7 days after the initial procedure. Median follow-up was 173 days (range 4-820 days). CONCLUSION: EUS-GBD is both technically feasible and effective for patients with acute cholecystitis and gallbladder perforation. While the AEs rate appears low, further studies are needed to confirm these findings.