Initial Experience With Endoscopic Ultrasound‐Guided Gallbladder Drainage Using Lumen‐apposing Metal Stents in Extremely Elderly and Frail Patients
Kiyoyuki Kobayashi, Takako Nomura, Maki Ayaki, Tomohiro Ogi, Yudai Sato, Manabu Yamada, Daisuke Namima, Naoki Fujita, Hiroki Yamana, Hideki Kamada, Toshiharu Funaki, Akihiro Kondo, Yasuhisa Ando, Hironobu Suto, Minoru Oshima, Keiichi Okano, Hideki KobaraABSTRACT
Objectives
Endoscopic ultrasound‐guided gallbladder drainage (EUS‐GBD) using lumen‐apposing metal stents (LAMS) is a treatment option for acute cholecystitis in high‐risk surgical patients. However, data on extremely elderly and frail patients are limited. We report our initial experience with EUS‐GBD using electrocautery‐enhanced LAMS in this population after reimbursement approval in Japan.
Methods
We retrospectively analyzed consecutive patients who underwent EUS‐GBD using electrocautery‐enhanced LAMS for acute cholecystitis at a single center after reimbursement approval in June 2025.
Results
Ten patients (median age, 90 years; median Clinical Frailty Scale score, 7) underwent EUS‐GBD. All procedures were performed via a transduodenal approach using a 10‐mm LAMS. Technical success was achieved in all patients. Clinical success was achieved in nine of the 10 patients (90%); one patient with Grade III cholecystitis complicated by severe pneumonia and heart failure died on postoperative day 1 before clinical assessment. The median stent deployment time was 3.5 min, and the median total procedure time was 16 min. Cholecystoscopy through the LAMS using a slim endoscope was feasible when required.
Conclusion
In this pilot study, EUS‐GBD using electrocautery‐enhanced LAMS was technically successful in extremely elderly and frail patients. Although short‐term outcomes appeared acceptable in most patients, the single POD1 death underscores the importance of careful patient selection. These preliminary findings require validation in larger studies.
Trial Registration
N/A.