EUS‐Guided Gallbladder Drainage for Acute Cholecystitis in the Western World: Heterogeneity in Current Practice and the Relation With Patient Outcome

Background Laparoscopic cholecystectomy is the standard treatment for acute cholecystitis (AC), but some patients are unfit for (immediate) surgery. Endoscopic ultrasound‐guided gallbladder drainage (EUS‐GBD) using a lumen‐apposing metal stent (LAMS) is increasingly used in this population. Objective This multicenter cohort study aimed to evaluate practice patterns in EUS‐GBD across Western centers and to identify factors that influence outcomes. Design We retrospectively analyzed data from patients undergoing EUS‐GBD for AC across 18 centers. Patient‐related, procedural and outcome data were collected. The primary outcomes of interest were LAMS‐related adverse events (AEs), recurrent biliary disease, recurrent acute cholecystitis, and all‐cause mortality. Time‐to‐event analyses were performed using center‐stratified Cox proportional hazards and Fine–Gray competing‐risk models to identify LAMS procedural factors associated with clinical outcomes. Results We included 496 patients with a median follow‐up of 176 days (IQR 44–569). Technical and clinical success rates of EUS‐GBD were 98.2% and 93.5%, respectively. LAMS‐related AEs and recurrent biliary disease occurred in 11.1% and 18.8% of patients, respectively. Transduodenal access was associated with a lower cumulative incidence of LAMS‐related AEs compared with transgastric access (SHR 0.42, 95% CI 0.23–0.76, p = 0.004) and lower rates of recurrent biliary disease and recurrent acute cholecystitis during follow‐up. Larger LAMS diameters (> 10 mm) were associated with a lower risk of recurrent acute cholecystitis and all‐cause mortality. No association between coaxial DPPS placement and improved long‐term outcomes could be demonstrated after competing‐risk adjustment. Among patients undergoing interval cholecystectomy ( N = 46), LAMS‐related conversion from laparoscopy to laparotomy occurred in 3 cases (6.5%). Conclusions In this large cohort study, transduodenal access route and choice of a large (> 10 mm) LAMS diameter were associated with improved outcomes of EUS‐GBD. EUS‐GBD may be a feasible option as a bridge to laparoscopic cholecystectomy, with limited risk of conversion to laparotomy. The findings of our study require prospective validation.