EUS‐Guided Gallbladder Drainage for Acute Cholecystitis in the Western World: Heterogeneity in Current Practice and the Relation With Patient Outcome

BACKGROUND: Laparoscopic cholecystectomy is the standard treatment for acute cholecystitis (AC), but some patients are unfit for (immediate) surgery. Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using a lumen-apposing metal stent (LAMS) is increasingly used in this population. OBJECTIVE: This multicenter cohort study aimed to evaluate practice patterns in EUS-GBD across Western centers and to identify factors that influence outcomes. DESIGN: We retrospectively analyzed data from patients undergoing EUS-GBD for AC across 18 centers. Patient-related, procedural and outcome data were collected. The primary outcomes of interest were LAMS-related adverse events (AEs), recurrent biliary disease, recurrent acute cholecystitis, and all-cause mortality. Time-to-event analyses were performed using center-stratified Cox proportional hazards and Fine-Gray competing-risk models to identify LAMS procedural factors associated with clinical outcomes. RESULTS: We included 496 patients with a median follow-up of 176 days (IQR 44-569). Technical and clinical success rates of EUS-GBD were 98.2% and 93.5%, respectively. LAMS-related AEs and recurrent biliary disease occurred in 11.1% and 18.8% of patients, respectively. Transduodenal access was associated with a lower cumulative incidence of LAMS-related AEs compared with transgastric access (SHR 0.42, 95% CI 0.23-0.76, p = 0.004) and lower rates of recurrent biliary disease and recurrent acute cholecystitis during follow-up. Larger LAMS diameters (> 10 mm) were associated with a lower risk of recurrent acute cholecystitis and all-cause mortality. No association between coaxial DPPS placement and improved long-term outcomes could be demonstrated after competing-risk adjustment. Among patients undergoing interval cholecystectomy (N = 46), LAMS-related conversion from laparoscopy to laparotomy occurred in 3 cases (6.5%). CONCLUSIONS: In this large cohort study, transduodenal access route and choice of a large (> 10 mm) LAMS diameter were associated with improved outcomes of EUS-GBD. EUS-GBD may be a feasible option as a bridge to laparoscopic cholecystectomy, with limited risk of conversion to laparotomy. The findings of our study require prospective validation.

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Journal
United European Gastroenterology Journal
Published
2026-08-13
DOI
https://doi.org/10.1002/ueg2.70275
Primary Topic
Gallbladder and Bile Duct Disorders
Type
article
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article

EUS‐Guided Gallbladder Drainage for Acute Cholecystitis in the Western World: Heterogeneity in Current Practice and the Relation With Patient Outcome

Michele Amata, Roy L.J. van Wanrooij, Rogier P. Voermans, Koen Robert Beukema et al.
United European Gastroenterology Journal
Gallbladder and Bile Duct Disorders
article

EUS‐Guided Gallbladder Drainage for Acute Cholecystitis in the Western World: Heterogeneity in Current Practice and the Relation With Patient Outcome

Michele Amata, Roy L.J. van Wanrooij, Rogier P. Voermans, Koen Robert Beukema, Daniela Scimeca, S Stefanović, Hannah van Malenstein, Willem J. Lammers, Enrique Pérez‐Cuadrado‐Robles, Christophe Snauwaert, Shirley Jiang, Ellen Deschepper, Eva Hufkens, Roberto Di Mitri, Alexander Arlt, Pieter Hindryckx, Alberto Larghi, Elise Devolder, Niels G. Venneman, Helena Degroote, Cynthuja Thilakanathan, Wim Laleman, Van der Merwe, Roberto Trasolini, Thomas Billiet, Michiel Bronswijk, Dennis J. Yang, Anouk G. Overdevest, Emine Gökce, Dominiek De Wulf, Lionel D’Souza, Natalie Cosgrove, Muhammad K. Hasan, Pieter Jan de Jonge, Kambiz Kadkhodayan, Felice Molinario, Louis De Wispelaere, Mustafa Arain, Maham Hayat, Douglas G. Adler, Antonio Pelegrino, Marco J. Bruno
article en

Abstract

BACKGROUND: Laparoscopic cholecystectomy is the standard treatment for acute cholecystitis (AC), but some patients are unfit for (immediate) surgery. Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using a lumen-apposing metal stent (LAMS) is increasingly used in this population. OBJECTIVE: This multicenter cohort study aimed to evaluate practice patterns in EUS-GBD across Western centers and to identify factors that influence outcomes. DESIGN: We retrospectively analyzed data from patients undergoing EUS-GBD for AC across 18 centers. Patient-related, procedural and outcome data were collected. The primary outcomes of interest were LAMS-related adverse events (AEs), recurrent biliary disease, recurrent acute cholecystitis, and all-cause mortality. Time-to-event analyses were performed using center-stratified Cox proportional hazards and Fine-Gray competing-risk models to identify LAMS procedural factors associated with clinical outcomes. RESULTS: We included 496 patients with a median follow-up of 176 days (IQR 44-569). Technical and clinical success rates of EUS-GBD were 98.2% and 93.5%, respectively. LAMS-related AEs and recurrent biliary disease occurred in 11.1% and 18.8% of patients, respectively. Transduodenal access was associated with a lower cumulative incidence of LAMS-related AEs compared with transgastric access (SHR 0.42, 95% CI 0.23-0.76, p = 0.004) and lower rates of recurrent biliary disease and recurrent acute cholecystitis during follow-up. Larger LAMS diameters (> 10 mm) were associated with a lower risk of recurrent acute cholecystitis and all-cause mortality. No association between coaxial DPPS placement and improved long-term outcomes could be demonstrated after competing-risk adjustment. Among patients undergoing interval cholecystectomy (N = 46), LAMS-related conversion from laparoscopy to laparotomy occurred in 3 cases (6.5%). CONCLUSIONS: In this large cohort study, transduodenal access route and choice of a large (> 10 mm) LAMS diameter were associated with improved outcomes of EUS-GBD. EUS-GBD may be a feasible option as a bridge to laparoscopic cholecystectomy, with limited risk of conversion to laparotomy. The findings of our study require prospective validation.

United European Gastroenterology JournalVol. 14(7)
HOGENT University of Applied Sciences and Arts (BE), Université Paris Cité (FR), AdventHealth Orlando (US), Porter Adventist Hospital (US), Universitair Ziekenhuis Leuven (BE), AZ Groeninge (BE), Ghent University Hospital (BE), Stony Brook University Hospital (US), Medisch Spectrum Twente (NL), Erasmus MC (NL), Erasmus Hospital (BE), Agostino Gemelli University Polyclinic (IT), Vancouver General Hospital (CA), Ghent University (BE), Assistance Publique – Hôpitaux de Paris (FR), Hôpital Européen Georges-Pompidou (FR), Amsterdam Neuroscience (NL), Klinikum Oldenburg (DE), AZ Sint-Jan (BE), Imelda Hospital (BE), AZ Delta (BE), Azienda di Rilievo Nazionale ed Alta Specializzazione (IT), Cancer Center Amsterdam (NL), IEDC-Bled School of Management (SI), University of Amsterdam (NL)
Boston Scientific Corporation
Good health and well-being
Openalex Percentile: Top 10%
Gallbladder and Bile Duct Disorders
DOIOpen Access PDFOpenAlex
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