Long-term Outcomes of Elective EUS-guided Gallbladder Drainage After Percutaneous Transhepatic Gallbladder Drainage

Abstract

ABSTRACT Background Endoscopic ultrasound (EUS)-guided gallbladder drainage (GBD) has gained increasing popularity as an alternative treatment approach for acute cholecystitis in high-risk patients. We report the procedural and long-term outcomes of elective EUS-GBD using self-expandable metallic stents (SEMSs) after percutaneous transhepatic gallbladder drainage (PTGBD) for acute cholecystitis. Methods Between April 2015 and January 2017, 15 patients at the study institution underwent elective EUS-GBD after PTGBD. SEMSs were placed in all patients, and the external gallbladder catheter was removed one week after the procedure. Procedural and long-term outcomes were measured retrospectively. Results Both the technical and clinical success rates were 93.3% (14/15). Two patients (13.3%) developed adverse events, with distal stent migration in one patient (6.7%) and asymptomatic pneumoperitoneum in the other patient (6.7%). Cholecystitis recurred only in patients who experienced stent migration. None of the patients underwent elective cholecystectomy. The median duration of stent patency was 544 days (18-1006 days), without any deaths. The overall stent patency rate was 86.7% (13/15). Conclusion Thus, elective EUS-GBD using SEMSs after PTGBD exhibited favorable long-term outcomes, indicating that this approach is effective for patients with severe comorbidities that preclude open surgical cholecystectomy.