title: Long-term outcomes after endoscopic ultrasonography-guided gallbladder drainage for acute cholecystitis.
abstract: OBJECTIVE
  Endoscopic ultrasonography-guided transmural gallbladder drainage (EUS-GBD) has been proposed for the management of acute cholecystitis in high risk patients; however, little is known about the long-term outcomes of this treatment. The aim of this study was to evaluate the procedural and long-term outcomes of EUS-GBD with self-expandable metallic stent (SEMS).
  
  
  METHODS
  Data for this retrospective study were obtained from a prospectively collected EUS database. Patients with acute cholecystitis who were deemed unsuitable for cholecystectomy were included. Study outcomes were technical and clinical success, adverse events, and stent patency.
  
  
  RESULTS
  EUS-GBD was technically and clinically successful in 62/63 patients (98.4 %; 95 % confidence interval [CI] 94.9 % - 100 %). Procedural adverse events included duodenal perforation (n = 1, 1.6 %) and self-limiting pneumoperitoneum (n = 2, 3.2 %), all of which resolved with conservative treatment. Long-term outcomes of EUS-GBD were evaluated in 56 patients who were followed for a median of 275 days (range 40 - 1185 days). Late adverse events developed in four patients (7.1 %; 95 %CI 5.7 % - 8.4 %), including asymptomatic distal stent migration (n = 2), and acute cholecystitis due to stent occlusion (n = 2). Two patients with occluded stent were successfully treated endoscopically (reintervention rate of 3.6 %). A total of 54 patients (96.4 %) had no recurrence of acute cholecystitis during follow-up. Median stent patency time was 190 days overall (range 15 - 1185 days) and 458 days (range 151 - 1185 days) for the 28 patients who were alive at the study end. The cumulative stent patency rate was 86 % at 3 years.
  
  
  CONCLUSIONS
  EUS-GBD with an SEMS for acute cholecystitis showed excellent long-term outcomes and may be a definitive treatment in patients who are unsuitable for cholecystectomy because of advanced malignancy or high surgical risk.
authors: Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea.
authors: Jun-Ho
authors: JH
authors: Choi
authors: Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors: Sang Soo
authors: SS
authors: Lee
authors: Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors: Joon Hyuk
authors: JH
authors: Choi
authors: Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors: Do Hyun
authors: DH
authors: Park
authors: Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors: Dong-Wan
authors: DW
authors: Seo
authors: Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors: Sung Koo
authors: SK
authors: Lee
authors: Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors: Myung-Hwan
authors: MH
authors: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D041881:Cholecystitis, Acute / Q000209:etiology / Q000601:surgery*; D004322:Drainage / Q000009:adverse effects / Q000379:methods*; D019160:Endosonography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011027:Pneumoperitoneum / Q000209:etiology; D011475:Prosthesis Failure / Q000009:adverse effects; D012008:Recurrence; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional