S2194 Clinical Outcomes (≥1 Year) of EUS-Guided Gallbladder Drainage in Patients With Acute Cholecystitis: A Systematic Review and Meta-Analysis

Introduction: Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has emerged as a reliable management option in high-risk surgical patients with acute cholecystitis. While short-term efficacy and safety have been well demonstrated, data on outcomes 1≥ year remain limited. The use of lumen-apposing metal stents (LAMS) has enhanced the technical abilities of this approach. Guidelines now support the use of EUS-GBD over percutaneous transhepatic gallbladder drainage in this patient population. In this systematic review and meta-analysis, we aimed to assess the clinical success of individuals treated with EUS-GBD for acute cholecystitis, with a follow-up period ≥1 year. Methods: A comprehensive literature search was performed across Medline, Embase, Scopus, and the Cochrane Library from inception through April 2025. Studies reporting clinical outcomes of EUS-GBD for acute cholecystitis in adults with ≥1 year of follow-up were included. Primary outcomes were technical and clinical success. Secondary outcomes included rates of cholecystitis recurrence, readmission, reintervention, stent patency, and adverse events (AEs). Results: Eighteen studies met inclusion criteria (n = 701 patients). The pooled technical success rate was 95.8% (95% CI, 93.9–97.2; I² = 0%) and clinical success rate was 94.3% (95% CI, 92–96; I² = 0%). Cholecystitis recurrence ≥1 year after the procedure was 4.2% (95% CI, 2.8–6.2). Readmission occurred in 19% of patients (95% CI, 8.9–36; I² = 66%) and reintervention was required in 6% (95% CI, 3.6–9.8; I² = 0%). The need for repeat endoscopy due to stent occlusion was 2.9% (95% CI, 1.5–5.6), and pooled stent patency was 418.8 days (95% CI, 98.3–739.3). Adverse events included abdominal pain (4.4%), immediate bleeding (4.0%), delayed bleeding (5.1%), perforation (2.1%), and pneumoperitoneum (3.9%). Conclusion: This study demonstrates that EUS-GBD is a technically effective and clinically durable treatment modality for acute cholecystitis with ≥1 year follow up duration. There was a sustained clinical success rate with low recurrence and reintervention beyond one year. The overall low rate of AEs associated with EUS-GBD reflects its unique ability to care for those considered high risk for surgery. These findings reinforce the growing role of EUS-GBD as a first-line modality in non-operative candidates. Further prospective studies are needed to standardize post-procedural management and evaluate long-term stent strategies.