ABSTRACT Background and Aims Endoscopic ultrasound‐guided gallbladder drainage (EUS‐GBD) is the recommended treatment for high surgical risk patients with acute cholecystitis requiring drainage. Gallbladder perforation is a severe complication and is often considered a contraindication for endoscopic treatment. We report our experience with EUS‐GBD in patients with perforated cholecystitis. Methods This retrospective study analyzed consecutive cases of high surgical risk patients with acute cholecystitis and gallbladder perforation treated with EUS‐GBD at a tertiary referral center from September 2020 to October 2023. EUS‐GBD was performed using electrocautery‐enhanced lumen‐apposing metal stents (LAMS). Primary outcomes were technical and clinical success. Adverse events (AEs) were considered secondary endpoints. Results Twelve patients (50% women, mean age 75.9 ± 15.2 years) were included. The median Charlson Comorbidity Index was 7. Reasons for EUS‐GBD included age/comorbidities (33.3%), advanced malignancy (33.3%), and coagulopathy/dual antiplatelet therapy (33.3%). Technical success was achieved in all patients (100%), and clinical success was observed in 11/12 (91.7%), with significant improvement in localized and systemic infection. AEs occurred in one patient (8.33%) with pneumoperitoneum treated conservatively. The same patient experienced recurrent cholecystitis that required endoscopic stent revision 7 days after the initial procedure. Median follow‐up was 173 days (range 4–820 days). Conclusion EUS‐GBD is both technically feasible and effective for patients with acute cholecystitis and gallbladder perforation. While the AEs rate appears low, further studies are needed to confirm these findings.
Godat et al. (Wed,) studied this question.