Endoscopic Ultrasound-Guided Gallbladder Drainage Using Lumen-Apposing Metal Stents for Non-Surgical Candidates With Cholecystitis: A Prospective Cohort Study.

INTRODUCTION: Management of acute cholecystitis (AC) in high-risk surgical candidates is challenging. Drainage via percutaneous transhepatic gallbladder drainage (PT-GBD) has been standard of care, with high complication and re-intervention rates. Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using lumen-apposing metal stents (LAMS) is proposed as an alternative. This study evaluates the efficacy and safety of LAMS in EUS-GBD for non-surgical candidates presenting with AC.

METHODS: An institution-based prospective database has tracked all patients who undergo EUS-GBD using LAMS for AC. Within this database, we analysed outcomes of technical and clinical success rates, reintervention rates, adverse events, and mortality.

RESULTS: Thirty seven patients (20 females, 17 males; mean age 74.9 years) underwent EUS-GBD between July 2024 and December 2025. Patients were comorbid (mean Charlson Comorbidity Index 5.7), frail (mean Clinical Frailty Scale 4.2), and had high peri-operative risk (mean ASA score 3). EUS-GBD was technically and clinically successful in 100% and 94.6% of cases, respectively. Two patients (5.4%) required reintervention for LAMS occlusion with recurrent AC, and one patient was re-admitted with conservatively managed recurrence. Three patients died during follow up: two (5.4%) of sepsis despite intervention and one unrelated death 23 days post-procedure. There were no other adverse events after median follow up of 366 days.

DISCUSSION: EUS-GBD with LAMS is effective and safe for non-surgical candidates with AC. High success rates, coupled with low mortality and adverse events, support its role as the preferred option for drainage in non-surgical candidates. Larger prospective studies are warranted to confirm these findings.