title: EUS-guided gallbladder drainage in patients with acute cholecystitis and high surgical risk using an electrocautery-enhanced lumen-apposing metal stent device.
abstract: OBJECTIVE
  In high-risk surgical patients, the treatment of choice of acute cholecystitis is percutaneous transhepatic gallbladder drainage (PTGBD). Recently, a novel endoscopic device containing a lumen-apposing metal stent with an electrocautery (ECE-LAMS) on the tip has been developed.
  
  
  METHODS
  High-risk surgical patients with acute cholecystitis who underwent EUS-guided gallbladder drainage (EUS-GBD) with the novel device were retrospectively retrieved from 7 tertiary care referral centers. Main endpoints were technical and clinical success rates, rate of procedural adverse events, and short- and long-term adverse events.
  
  
  RESULTS
  Seventy-five patients (mean age, 75 ± 11 years; 36 men) underwent EUS-GBD. The procedure was technically and clinically successful in 98.7% and 95.9% of cases, respectively. Three patients without resolution of cholecystitis died, and 2 patients had procedure-related adverse events: 1 perforation requiring surgery and 1 major bleeding resolved conservatively. The mean follow-up for the entire cohort was 201 ± 226 days. Seven patients (9.6%) died within the first 30 days; 50 patients (71.4%) were alive at the last date of follow-up. Short- and long-term adverse events occurred in 6 patients: 3 had recurrent cholecystitis, 2 had migration of the stent, and 1 developed Bouveret syndrome, all managed nonsurgically. Overall, 8 adverse events (10.7%) occurred in the entire cohort of patients.
  
  
  CONCLUSIONS
  The novel ECE-LAMS for high-risk surgical patients with acute cholecystitis is safe, with a high technical and clinical success rate. Future multicenter studies comparing EUS-GBD versus PTGBD are warranted to determine which procedure is safer and clinically more effective for patients with high surgical risk acute cholecystitis.
authors.affiliation: Department of Gastroenterology, Klinikum Neuperlach, München, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Dollhopf
authors.affiliation: Digestive Endoscopy Unit, Catholic University, Rome, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Larghi
authors.affiliation: Department of Gastroenterology, Municipal Hospital, Gera, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Will
authors.affiliation: Digestive Endoscopy Unit, Catholic University, Rome, Italy; Gastroenterology and Internal Medicine Departments, Colentina Clinical Hospital, Carol Davila University of Medicine, Bucharest, Romania.
authors.forename: Mihai
authors.initials: M
authors.lastname: Rimbaş
authors.affiliation: Department of Gastroenterology, Digestive Endoscopy Unit, Humanitas Research Hospital, Rozzano, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Anderloni
authors.affiliation: Endoscopy Unit, Hospital Costa del Sol, Marbella, Spain.
authors.forename: Andres
authors.initials: A
authors.lastname: Sanchez-Yague
authors.affiliation: Department of Surgery, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China.
authors.forename: Anthony Yuen Bun
authors.initials: AYB
authors.lastname: Teoh
authors.affiliation: Department of Surgical Gastroenterology, L Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Rastislav
authors.initials: R
authors.lastname: Kunda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001662:Biliary Tract Surgical Procedures / Q000379:methods*; D041881:Cholecystitis, Acute / Q000601:surgery*; D004322:Drainage / Q000379:methods; D004564:Electrocoagulation / Q000379:methods*; D016145:Endoscopy, Digestive System / Q000379:methods; D019160:Endosonography; D005260:Female; D005548:Foreign-Body Migration / Q000453:epidemiology; D005704:Gallbladder / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D019106:Postoperative Hemorrhage / Q000453:epidemiology; D012008:Recurrence; D012189:Retrospective Studies; D012306:Risk; D000069322:Self Expandable Metallic Stents; D025321:Surgery, Computer-Assisted / Q000379:methods*