EUS
‐Guided Gallbladder Drainage in Acute Cholecystitis With Contained Perforation: An International Multicenter Study
Marco Spadaccini, Gianluca Franchellucci, Francesco Auriemma, Alessandro Fugazza, Andrea Lisotti, Andrea Anderloni, Giuseppe Dell'Anna, Gianfranco Donatelli, Francesco Maria Di Matteo, Serena Stigliano, Edoardo Forti, Massimiliano Mutignani, Abed Al‐Lehibi, Emad Aljahdli, Abdulrahmman Alfadda, Ammar Alotaibi, Resheed Alkhiari, Ilaria Tarantino, Cecilia Binda, Il Sang Shin, Jong Ho Moon, Pietro Fusaroli, Carlo Fabbri, Daryl Ramai, Antonio Facciorusso, Cesare Hassan, Alessandro Repici, Benedetto Mangiavillano, 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.