Endoscopic ultrasonography-guided gallbladder drainage using lumen-apposing metal stents

Abstract

Laparoscopic cholecystectomy is the standard of care for treatment of acute cholecystitis. When patients are deemed poor candidates for surgery, percutaneous cholecystostomy was historically performed for decompression of the gallbladder. Endoscopic transpapillary gallbladder drainage via endoscopic retrograde cholangiopancreatography (and endoscopic ultrasound (EUS) guided transmural gallbladder drainage (EUS-GBD) are 2 alternative techniques for gallbladder drainage. Over the last decade, there has been substantial progress in EUS-GBD technique, including use of covered self-expanding metal stents and lumen-apposing metal stents (LAMS). The unique design of LAMS results in apposition of gallbladder to duodenum/stomach and reduces the risk of adverse events. Recent studies comparing the outcomes of EUS-GBD using LAMS with percutaneous cholecystostomy and endoscopic transpapillary gallbladder drainage have reported results favoring EUS-GBD because of lower rates of adverse events. Furthermore, the use of LAMS for gallbladder drainage offers new opportunities for endoscopic management of gallbladder diseases through cholecystoscopy. Further studies are needed to assess optimal duration of stenting and safety of long-term stenting.

Endoscopic ultrasound-guided gallbladder drainage by transjejunal lumen-apposing metal stent placement in a patient with mini-gastric bypass

“…Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using lumen-apposing electrocautery-enhanced metal stent (EC-LAMS) is a safe and effective treatment option in patients with acute cholecystitis who are unfit for surgery [1]. We present the case of a 64-year-old woman who presented to the emergency department with a grade III cholecystitis [2] (▶ Fig.…”