Current Status of Endoscopic Gallbladder Drainage

The gold standard for treatment of acute cholecystitis is laparoscopic cholecystectomy. However, cholecystectomy is often not suitable for surgically unfit patients who are too frail due to various co-morbidities. As such, several less invasive endoscopic treatment modalities have been developed to control sepsis, either as a definitive treatment or as a temporizing modality until the patient is stable enough to undergo cholecystectomy at a later stage. Recent developments in endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) with endoscopic ultrasound EUS-specific stents having lumen-apposing properties have demonstrated potential as a definitive treatment modality. Furthermore, advanced gallbladder procedures can be performed using the stents as a portal. With similar effectiveness as percutaneous transhepatic cholecystostomy and lower rates of adverse events reported in some studies, EUS-GBD has opened exciting possibilities in becoming the next best alternative in treating acute cholecystitis in surgically unfit patients. The aim of this review article is to provide a summary of the various methods of gallbladder drainage GBD with particular focus on EUS-GBD and the many new prospects it allows.

A primary study on curative effects of endoscopic ultrasound-guided gallbladder drainage for patients with acute cholecystitis and high surgical risk / 中华消化内镜杂志

Objective To investigate the efficacy and safety of endoscopic ultrasound-guided gallbladder drainage ( EUS-GBD) for patients with acute cholecystitis, who are unfit for cholecystectomy. Methods Patients who underwent EUS-GBD at Hangzhou First People′s Hospital from April 2015 to December 2016 were enrolled in this study. Clinical data were collected, and effectiveness and complications were analyzed. Results EUS-GBD was achieved in all 5 patients, and the mean procedure time of EUS-GBD was 26. 0±3. 1 min. Double pigtail plastic stents were successfully placed in 4 patients. A nasobiliary drainage tube was placed in 1 patient and the tube was endoscopically cut 5 days after procedure acting as internal drainage. All patients recovered without complications and no procedure-related death occurred. During the follow-up period (46-692 d), no patient experienced recurrent cholecystitis and stent migration. Conclusion At an experienced endoscopic center, EUS-GBD is a safe, effective and minimally invasive method for patients with acute cholecystitis and high surgical risk.