EUS-guided transmural cholecystostomy as rescue management for acute cholecystitis in elderly or high-risk patients: a prospective feasibility study

Abstract

Background: Although EUS-guided drainage procedures have been used to collect peripancreatic fluids, little is known regarding EUS-guided transmural gallbladder drainage for high-risk patients with acute cholecystitis.

Objective: Our purpose was to evaluate the technical feasibility and outcomes of EUS-guided transmural cholecystostomy as rescue management in elderly and high-risk patients with acute cholecystitis.

Design: Single-center prospective study.

Setting: Tertiary referral center.

Patients: Nine elderly or high-risk patients diagnosed with acute cholecystitis.

Interventions: All inflamed gallbladders were drained by EUS-guided transmural cholecystostomy.

Main outcome measurement: Clinical resolution of acute cholecystitis.

Results: After the drainage procedures, there were no immediate complications such as bleeding, bile leak, or peritonitis, except for 1 patient who had pneumoperitoneum. After EUS-guided transmural cholecystostomy, all patients showed rapid clinical improvement within 72 hours.

Limitations: Small number of patients.

Conclusion: EUS-guided transmural cholecystostomy may be feasible and safe as initial, interim, or even definitive treatment of patients with severe acute cholecystitis who are at high operative risk for immediate cholecystectomy.