EUS-guided gallbladder drainage

Although laparoscopic cholecystectomy is the treatment of choice in patients with acute cholecystitis, this procedure is unsuitable for patients of advanced age or with advanced malignancy or underlying comorbidities. Currently, nonsurgical gallbladder drainage is performed by percutaneous and endoscopic drainage procedures. Percutaneous transhepatic gallbladder drainage (PTGBD) has been the most established salvage for gallbladder drainage in patients unresponsive to medical therapy, or who are at high risk for cholecystectomy,with clinical response rates of 78-100%. However, PTGBD may be inappropriate for patients with massive ascites or severe coagulopathy, and patient discomfort and postprocedure pain have been associated with the percutaneous drainage catheters. Furthermore, inadvertent catheter dislodgement or migration have been reported in 0.3% to 12% of patients.. EUS-guided transmural gallbladder drainage (EUS-GBD) is gaining favor as an attractive alternative for managing acute cholecystitis in high-risk patients.22-27 The advantages of EUS-GBD are the avoidance of external drainage, unlike the PTGBD, and potentially no risk of post-ERCP pancreatitis or cholangitis, unlike transpapillary drainage. The technical success rate and safety of EUS-GBD is comparable to those of PTGBD. Recently our group evaluated the long-term outcomes of EUS-GBD with metal stent. The recurrence rate of acute cholecystitis or GB related symptom was only 3.6% in patients who were critically ill or had severe cormobidity during follow-up period. In conclusion, EUS-GBD has excellent potential as an alternative gallbladder decompression procedure. Given the limited survival and a low rate of reintervention, EUS-GBD with metal stent may provide definitive treatment in high risk patients with acute cholecystitis.