Comparison of plastic stents and lumen-apposing metal stents in endoscopic ultrasound-guided gallbladder drainage for acute cholecystitis in high-risk surgical patients

Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) for acute cholecystitis (AC) has a high technical and clinical success rate and is beneficial for patients’ quality of life due to internal fistula drainage, especially for high-risk surgical patients. Two drainage devices (plastic stent [PS] and lumen-apposing metal stent [LAMS]) are available; however, suitable drainage devices remain unclear. Between 2016 and 2026, 20 PS and 20 LAMS placement high-risk surgical AC were compared. Technical and clinical success rates, the number of dilation cases for the puncture route, procedure time, adverse events (AEs), and hospital stay were evaluated. There was no significant difference in patients’ backgrounds, except for the number of prior percutaneous gallbladder drainage cases (75% in PS group vs. 10% in LAMS group; P < 0.01). The shortest gallbladder diameter tended to be larger in the LAMS (30-mm) than in the PS group (25-mm; P = 0.052). Dilation of the puncture site was required in all PS cases. The technical and clinical success rates were 100% in both groups. EUS-GBD procedure time was significantly shorter in the LAMS group (7 min. vs. 21 min.; P < 0.01). The AEs occurrence rate was significantly higher in the PS group (40% vs. 5%; P = 0.02), and the hospital stay was shorter in the LAMS group (10 vs. 34 days; P = 0.047). Technical and clinical success did not differ between LAMS and PS. In this exploratory analysis, LAMS was associated with shorter procedure time and hospital stay and fewer AEs, suggesting it may be a safe, useful option. Clinical trial registration : UMIN000060137.