Feasibility and safety of EUS-guided transgastric/transduodenal gallbladder drainage with single-step placement of a modified covered self-expandable metal stent in patients unsuitable for cholecystectomy.

BACKGROUND

Although early laparoscopic cholecystectomy is the treatment of choice for patients with acute cholecystitis, percutaneous cholecystostomy has been performed in patients unsuitable for cholecystectomy. EUS-guided transgastric/transduodenal gallbladder drainage by using a plastic stent and/or nasobiliary drainage may be an alternative effective treatment for these patients, but bile leakage into the peritoneal space causing bile peritonitis is not uncommon during placement of a plastic stent.

OBJECTIVE

To evaluate the technical feasibility and safety of EUS-guided transgastric/transduodenal gallbladder drainage with single-step placement of a modified covered self-expandable metal stent (CSEMS) in patients with acute cholecystitis who are unsuitable for cholecystectomy.

DESIGN

Prospective feasibility study.

SETTING

Tertiary-care referral center.

PATIENTS: This study involved 15 patients with acute cholecystitis who did not respond to initial medical treatment and were unsuitable for cholecystectomy.

INTERVENTION: EUS-guided transgastric/transduodenal gallbladder drainage with single-step placement of a modified CSEMS.

MAIN OUTCOME MEASUREMENTS: Technical success, functional success, complications associated with the placement of a metal stent, and recurrence of acute cholecystitis.

RESULTS

Modified CSEMSs were successfully placed in all patients through the stomach (n = 10) or duodenum (n = 5). All patients achieved functional success within 3 days of metal stent placement. Pneumoperitoneum occurred in two patients during or after the procedure, but both patients improved with conservative management. During follow-up (median 145 days, range 60-297 days), no patient experienced recurrent cholecystitis.

LIMITATIONS: Small patient population without long-term follow-up.

CONCLUSION

Placement of a modified CSEMS after EUS-guided transgastric/transduodenal gallbladder drainage may be a feasible and safe alternative to treatments such as percutaneous cholecystostomy in patients with acute cholecystitis who are unsuitable for cholecystectomy.