EUS-guided cholecystenterostomy: a new technique (with videos)

BackgroundThe cornerstone of management for acute cholecystitis is cholecystectomy. However, surgical intervention is contraindicated in the occasional patient. EUS-guided transduodenal gallbladder drainage may represent an effective minimally invasive alternative.ObjectivesTo describe a new technique, EUS-guided cholecystenterostomy.Design and SettingA single-center retrospective case series.PatientsThree patients with severe acute cholecystitis unresponsive to conservative management who were deemed unfit for cholecystectomy.InterventionsUnder combined EUS and fluoroscopic guidance, cholecystenterostomy was performed via needle puncture, guidewire insertion, cystoenterostome passage, and stent placement.Main Outcome MeasuresTechnical success, clinical progress, immediate and long-term complications, and recurrence of cholecystitis.LimitationsPilot series.ResultsCholecystenterostomy was performed successfully in all patients. Rapid improvement in clinical status and inflammatory parameters ensued. A minor intraprocedural bile leak occurred in 1 patient, without significant clinical sequelae. Cholecystitis did not recur in any patient.ConclusionsEUS-guided cholecystenteric drainage is technically feasible and appears to be a safe and effective procedure. Via this technique, gallbladder drainage and resolution of related sepsis may be achieved in patients with acute cholecystitis who are unfit for surgery.