Pitfalls of endoscopic ultrasound-guided gallbladder drainage using a lumen-apposing metal stent: impact of the intraluminal water-filling technique

Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using a lumen-apposing metal stent (LAMS) is now widely attempted in patients for whom surgical treatment is contraindicated [1] [2]. When an electrocautery-enhanced LAMS (Hot AXIOS, Boston Scientific) is deployed, the distance between the gallbladder and the lumen should be <1 cm to prevent stent misdeployment. During maneuvering of the echoendoscope to identify the gallbladder, the intestinal wall may sometimes be folded and, as a result, the distance between the gallbladder and the lumen may be measured as being further away than it actually is. This finding may result in a false contraindication to EUS-GBD using a LAMS. In addition, if EUS-GBD is performed in this situation, double mucosal puncture can occur. To prevent these errors, the water-filling technique may be useful. Here, we describe some technical tips for EUS-GBD using a LAMS combined with the water-filling technique.