Endoscopic ultrasound-guided gallbladder drainage in acute cholecystitis with contained perforation: a prospective cohort study (with video)

Background: Endoscopic Ultrasound-guided Gallbladder Drainage (EUS-GBD) is usually contraindicated in perforated cholecystitis, although initial reports suggest feasibility in contained perforation (cp-AC). Methods: This prospective single-centre cohort study aimed at exploring EUS-GBD outcomes of patients with cp-AC (type 2 of Niemeier classification). A secondary exploratory comparison was performed with a contemporary cohort of patients with intact gallbladder walls (iw-AC). Results: Between Jan-2021 and Mar-2025, 23 cp-AC patients (39.7% of the overall EUS-GBD cohort) were enrolled. This subgroup showed high prevalence of underlying malignancy (87%) and former ERCP with metal stents (65.2%). Median operative space end interluminal distance were 30.5 [26.0-37.0] mm and 5 [2-8] mm respectively. Technical and Clinical success of EUS-GBD were 100% (85.7%-100.0%) and 87% (67.9%-95.5%) respectively. Adverse Events rate was 21.7% (9.7%-41.9%) and did not significantly differ from the contemporary iw-AC cohort. However, two fatal events were registered in the cp-AC group. Conclusions: EUS-GBD appears technically feasible in patients with contained perforation, despite the additional complexity. However, this represents a particularly high-risk population, and the procedure may be considered for carefully selected patients in expert centers.