Elective endoscopic treatment of benign gallbladder diseases in high-surgical risk patients: a retrospective study.

BACKGROUND AND AIMS: EUS-guided gallbladder drainage (EUS-GBD) has proved to be highly safe and effective in patients with acute cholecystitis at high surgical risk. These findings stimulated the search for populations outside the acute setting, where EUS-GBD performed electively could become a valid therapeutic option.

METHODS

This is a retrospective, multicenter, study involving patients who underwent elective endoscopic gallbladder treatment (EEGBT) in nine referral centers. All patients had a benign gallbladder disease and were judged to be at high surgical risk, with an indication to undergo cholecystectomy. EUS-GBD was performed using LAMSs and followed by intra-gallbladder lithotripsy when necessary. Primary outcome was adverse events (AE) rate; secondary outcomes included technical and clinical success rates and need for additional intracholecystic procedures.

RESULTS

Forty-nine patients (mean age 78.7 ± 12.3 years, M/F 22/27) underwent EEGBT over a 2-year period. All patients had ASA score ≥ 3, and a Charlson Comorbidity Index ≥ 5 was present in 71% of them. The most frequent indication was recurrent mild acute cholecystitis (42.9%). Technical success was achieved in all patients, with LAMS implantation more frequently performed from the duodenum (67.3%). AEs occurred in 3/49 (6.1%) and included 2 cases of stent occlusion-related cholecystitis, and one case of cholangitis all successfully treated endoscopically. One patient was lost at follow-up after the procedure. Intracholecystic lithotripsy was required in 12.5% of patients (6/48). Clinical success was obtained in 100% of cases. There were no EEGBT-related deaths.

CONCLUSION

EEGBT has high technical and clinical success rates, with an acceptable safety profile. Prospective studies to standardize procedural aspects and develop dedicated accessories for this procedure are needed.