S2297 EUS-Gallbladder Drainage vs Percutaneous Cholecystostomy for Management of Acute Cholecystitis in the Non-Surgical Patient: Assessment of Demographic, Racial, and Gender Outcomes

Introduction: Acute cholecystitis (AC) is a common disorder for which cholecystectomy is typically offered, unless patients are too acutely or chronically ill-suited for cholecystectomy. Percutaneous cholecystostomy (PC) has been historically offered in this setting, but EUS-gallbladder drainage (EUS-GBD) is emerging as a valuable management option for these patients. Methods: We retrospectively analyzed prospectively collected data for EUS-GBD patients in our 5-hospital system. We also randomly selected and retrospectively analyzed 128 PC patients out of 1,179 patients who underwent PC in our system from 2015 until 2025. Results: From 2019 to 2025, 64 patients were referred for EUS-GBD. Of the 128 PC patients, 66 patients (51.6%) were able to undergo eventual cholecystectomy, leaving 62 PC patients for comparison with EUS-GBD. PC patients were older (80.6 vs 73.3 years, P = 0.003) and were more likely to have cancer (66.1 vs 40.6%, P = 0.009); however, there was no difference between EUS-GBD vs PC with regard to gender (46.9% woman in EUS-GBD vs 32.3% in PC, P = 0.14), Charlson Comorbidity Index (7.8 ± 3.1 vs 7.2 ± 2.7, P = 0.3), patients with metastatic cancer (30.0% vs 24.2%, P = 0.4), congestive heart failure, coronary arterial disease, obstructive pulmonary disease, stroke, end stage renal disease, advanced dementia, or cirrhosis. While both groups had statistically comparable composition of White and racial minorities (P = 0.054), EUS-GBD patients had statistically higher composition of Hispanic patients (12.5% vs 1.6%, P = 0.008). Technical success did not vary significantly by age, race, or gender. Conclusion: In our system, PC patients were older and more likely to have cancer than patients undergoing EUS-GBD, but both groups had similar Charlson Comorbidity Index scores, indicating equivalent comorbidity burden. On the basis of gender, there were no significant differences in outcomes between both treatment options. EUS-GBD patients were comprised of a more heterogeneous patient population with higher percentage of Hispanic patients than the PC cohort, but there were no differences observed across the different racial backgrounds between both arms. EUS-GBD is a viable option for all non-surgical patients with AC.