EUS-guided transmural cholecystostomy as rescue management for acute cholecystitis in elderly or high-risk patients: a prospective feasibility study.

BACKGROUND: Although EUS-guided drainage procedures have been used to collect peripancreatic fluids, little is known regarding EUS-guided transmural gallbladder drainage for high-risk patients with acute cholecystitis.

OBJECTIVE: Our purpose was to evaluate the technical feasibility and outcomes of EUS-guided transmural cholecystostomy as rescue management in elderly and high-risk patients with acute cholecystitis.

DESIGN: Single-center prospective study.

SETTING: Tertiary referral center.

PATIENTS: Nine elderly or high-risk patients diagnosed with acute cholecystitis.

INTERVENTIONS: All inflamed gallbladders were drained by EUS-guided transmural cholecystostomy.

MAIN OUTCOME MEASUREMENT: Clinical resolution of acute cholecystitis.

RESULTS: After the drainage procedures, there were no immediate complications such as bleeding, bile leak, or peritonitis, except for 1 patient who had pneumoperitoneum. After EUS-guided transmural cholecystostomy, all patients showed rapid clinical improvement within 72 hours.

LIMITATIONS: Small number of patients.

CONCLUSION: EUS-guided transmural cholecystostomy may be feasible and safe as initial, interim, or even definitive treatment of patients with severe acute cholecystitis who are at high operative risk for immediate cholecystectomy.