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

BackgroundAlthough 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.ObjectiveOur 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.DesignSingle-center prospective study.SettingTertiary referral center.PatientsNine elderly or high-risk patients diagnosed with acute cholecystitis.InterventionsAll inflamed gallbladders were drained by EUS-guided transmural cholecystostomy.Main Outcome MeasurementClinical resolution of acute cholecystitis.ResultsAfter 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.LimitationsSmall number of patients.ConclusionEUS-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.