Endoscopic Ultrasound‐Guided Gallbladder Drainage Using Lumen‐Apposing Metal Stents for Non‐Surgical Candidates With Cholecystitis: A Prospective Cohort Study

Introduction Management of acute cholecystitis (AC) in high‐risk surgical candidates is challenging. Drainage via percutaneous transhepatic gallbladder drainage (PT‐GBD) has been standard of care, with high complication and re‐intervention rates. Endoscopic ultrasound‐guided gallbladder drainage (EUS‐GBD) using lumen‐apposing metal stents (LAMS) is proposed as an alternative. This study evaluates the efficacy and safety of LAMS in EUS‐GBD for non‐surgical candidates presenting with AC. Methods An institution‐based prospective database has tracked all patients who undergo EUS‐GBD using LAMS for AC. Within this database, we analysed outcomes of technical and clinical success rates, reintervention rates, adverse events, and mortality. Results Thirty seven patients (20 females, 17 males; mean age 74.9 years) underwent EUS‐GBD between July 2024 and December 2025. Patients were comorbid (mean Charlson Comorbidity Index 5.7), frail (mean Clinical Frailty Scale 4.2), and had high peri‐operative risk (mean ASA score 3). EUS‐GBD was technically and clinically successful in 100% and 94.6% of cases, respectively. Two patients (5.4%) required reintervention for LAMS occlusion with recurrent AC, and one patient was re‐admitted with conservatively managed recurrence. Three patients died during follow up: two (5.4%) of sepsis despite intervention and one unrelated death 23 days post‐procedure. There were no other adverse events after median follow up of 366 days. Discussion EUS‐GBD with LAMS is effective and safe for non‐surgical candidates with AC. High success rates, coupled with low mortality and adverse events, support its role as the preferred option for drainage in non‐surgical candidates. Larger prospective studies are warranted to confirm these findings.