STATUS OF ENDOSCOPIC ULTRASOUND-GUIDED GALLBLADDER DRAINAGE FOR ACUTE CHOLECYSTITIS AND PERSPECTIVES ON FUTURE DEVELOPMENTS

Abstract

While early laparoscopic cholecystectomy is the first-line treatment option for acute cholecystitis, gallbladder drainage is prerequisite in patients who are unfit for surgery. Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has recently drawn increasing attention as an alternative to conventional percutaneous transhepatic and endoscopic transpapillary gallbladder drainage. In this method, lumen-apposing metal stents (LAMS) have been shown to achieve higher clinical success rates with fewer recurrences and readmissions. In Japan, LAMS were approved in June 2025 for non-surgical candidate patients. Their wider adoption is anticipated. Appropriate patient selection and sufficient technical expertise remain essential to prevent severe adverse events. Although expansion of indications for preoperative drainage is under consideration, challenges remain, including elucidating its impacts on elective surgery.