Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has been introduced as an alternative to percutaneous transhepatic gallbladder drainage for the treatment of acute cholecystitis in non-surgical candidates. A systematic review of the English language literature through PubMed search until June 2014 was conducted. One hundred and fifty-five patients with acute cholecystitis treated with EUS-GBD in eight studies and 12 case reports, and two patients with EUS-GBD for other causes were identified. Overall, technical success was obtained in 153 patients (97.45%) and clinical success in 150 (99.34%) patients with acute cholecystitis. Adverse events developed in less than 8% of patients, all of them managed conservatively. EUS-GBD has been performed with plastic stents, nasobiliary drainage tubes, standard or modified tubular self-expandable metal stents (SEMS) and lumen-apposing metal stents (LAMS) by different authors with apparently similar outcomes. No comparison studies between stent types for EUS-GBD have been reported. EUS-GBD is a promising novel alternative intervention for the treatment of acute cholecystitis in high surgical risk patients. Feasibility, safety and efficacy in published studies from expert centers are very high compared to currently available alternatives. Further studies are needed to establish the safety and longterm outcomes of this procedure in other practice settings before EUS-GBD can be widely disseminated.Keywords Acute cholecystitis · Endoscopic drainage · Endoscopic ultrasound-guided drainage · Endoscopic ultrasound-guided gallbladder drainage · Lumen-apposing metal stents · Metal stent · Nasobiliary drainage · Self-expandable metal stents

LAMS migration occurs in 1 out of 7 cases and is most common when treating PFCs. Bleeding related to LAMS placement occurs much less commonly but can be life-threatening.

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Background EUS-guided ductal access and drainage (EUS-DAD) of biliary/pancreatic ducts after failed ERCP is less invasive than percutaneous transhepatic biliary drainage (PTBD). The actual need for EUS-DAD remains unknown. We aimed to determine how often EUS-DAD is needed to overcome ERCP failure. Methods Consecutive duct access procedures (n=2205; 95% biliary) performed between June 2013-November 2015 at a tertiary-care center were reviewed. ERCP was used first-line, EUS-DAD as salvage of ERCP, and PTBD when both failed. Procedures were defined as index in patients without prior endoscopic duct access and combined when EUS-DAD followed successful ERCP. The main outcomes were EUS-DAD and PTBD rates. Results EUS-DAD was performed overall in 7.7% (170/2205), 9.1% (116/1274) index and 5.8% (54/931) follow-up procedures. Most index EUS-DADs were performed following (46%) or anticipating (39%) ERCP failure, whereas 15% followed successful ERCP (combined procedures). Among index procedures, the EUS-DAD rate was higher in surgically-altered anatomy (58.2% [39/67)] vs. 6.4% [77/1207]). PTBD was required in 0.2% (3/1274). Among follow-up procedures, ERCP represented 85.7%, cholangio-pancreatography through mature transmural fistulas 8.5% and EUS-DAD 5.8%. No patient required PTBD. The secondary PTBD rate was 0.1% (3/2205). Six primary PTBDs were performed (0.4% [9/2211] overall PTBD rate). Conclusions EUS-DAD was required in 7.7% of ERCPs for benign and malignant biliary/pancreatic duct indications. Salvage PTBD was required in 0.1%. This high EUS-DAD rate reflects disease complexity, a wide definition of ERCP failure and restrictive PTBD use, not poor ERCP skills. EUS-DAD effectively overcomes ERCP limitations precluding primary and salvage PTBD in most cases.