Initial Experience With Endoscopic Ultrasound‐Guided Gallbladder Drainage Using Lumen‐apposing Metal Stents in Extremely Elderly and Frail Patients

Objectives: Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using lumen-apposing metal stents (LAMS) is a treatment option for acute cholecystitis in high-risk surgical patients. However, data on extremely elderly and frail patients are limited. We report our initial experience with EUS-GBD using electrocautery-enhanced LAMS in this population after reimbursement approval in Japan. Methods: We retrospectively analyzed consecutive patients who underwent EUS-GBD using electrocautery-enhanced LAMS for acute cholecystitis at a single center after reimbursement approval in June 2025. Results: Ten patients (median age, 90 years; median Clinical Frailty Scale score, 7) underwent EUS-GBD. All procedures were performed via a transduodenal approach using a 10-mm LAMS. Technical success was achieved in all patients. Clinical success was achieved in nine of the 10 patients (90%); one patient with Grade III cholecystitis complicated by severe pneumonia and heart failure died on postoperative day 1 before clinical assessment. The median stent deployment time was 3.5 min, and the median total procedure time was 16 min. Cholecystoscopy through the LAMS using a slim endoscope was feasible when required. Conclusion: In this pilot study, EUS-GBD using electrocautery-enhanced LAMS was technically successful in extremely elderly and frail patients. Although short-term outcomes appeared acceptable in most patients, the single POD1 death underscores the importance of careful patient selection. These preliminary findings require validation in larger studies. Trial Registration: N/A.