Long-term Outcomes after Endoscopic Ultrasound-Guided Gallbladder Drainage for Acute Cholecystitis

Abstract

Cholecystectomy is the standard treatment for acute cholecystitis; however, drainage is required in patients with poor condition or on antithrombotic therapy. Percutaneous transhepatic gallbladder drainage (PTGBD) involves external fistula formation, while endoscopic transpapillary gallbladder drainage (ETGBD) has low success rates and risk of post-ERCP pancreatitis. Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) enables internal drainage and is useful. In our hospital, self-expandable metal stents (SEMS) were mainly used, but long-term placement caused late adverse events such as fracture, migration, and duodenal ulcer stricture. Since 2017, elective exchange to plastic stent (PS) has been performed about two months after EUS-GBD. Among 51 patients undergoing EUS-GBD from 2016 to 2024, 46 with successful SEMS deployment were analyzed. 19 cases underwent PS exchange and 27 did not. Late adverse events occurred in 0% and 22.2% (6 cased), respectively (p=0.028). Median survival was 520 days. Elective PS exchange may prevent late adverse events after EUS-GBD.