EUS-Guided Gallbladder Drainage versus Dual Stent Transpapillary Gallbladder Drainage for Management of Acute Cholecystitis

Background and Aim: Cholecystectomy (CCY) is the standard treatment for acute cholecystitis. For non-surgical patients, percutaneous cholecystostomy tube (PT-GBD) is recommended but is associated with high readmission rates and poor quality-of-life. Endoscopic gallbladder decompression techniques, including endoscopic transpapillary gallbladder drainage (ET-GBD) and endoscopic ultrasound-guided gallbladder drainage (EUS-GBD), are alternatives. Studies comparing ET-GBD and EUS-GBD have shown EUS-GBD to have superior outcomes. However, these studies assessed ET-GBD mostly via single transcystic stent placement (SSET-GBD). This study aims to compare outcomes of dual transcystic stents (DSET-GBD) and EUS-GBD in non-surgical candidates with acute cholecystitis. Methods: A multicenter analysis was conducted on patients who underwent ET-GBD or EUS-GBD between January 2019 and January 2023. Data were extracted from electronic medical records and outcomes including technical success, success, adverse events, and recurrence rates of cholecystitis were measured. Results: Out of 129 procedures (56 EUS-GBD; 73 ET-GBD), technical success was achieved in 87.5% of EUS-GBD and 86.3% of ET-GBD attempts. Immediate clinical success was achieved in 98.1% for EUS-GBD and 100% for DSET-GBD. Adverse event rates were similar between the groups. Recurrent cholecystitis rates were 5.3% for EUS-GBD and 8.2% for DSET-GBD (p = 0.692). Conclusions: This study demonstrates that DSET-GBD has similarly low rates of recurrent acute cholecystitis compared to EUS-GBD. DSET-GBD should be considered as an alternative management strategy for the management of acute cholecystitis in patients who are unable to undergo CCY.

Publication History

Received: 24 June 2024

Accepted after revision: 16 December 2024

Accepted Manuscript online:
02 January 2025