Background: Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has become the favorite drainage option in high surgical-risk patients with acute cholecystitis. However, long-term outcomes regarding efficacy and security over 1 year are scarce.
Methods: We performed a retrospective review in a prospectively maintained database to analyze the 3-year long-term outcomes of EUS-GBD with lumen apposing metal stents (LAMS) in high surgical-risk patients with acute cholecystitis.
Results: Fifty patients with acute cholecystitis who underwent EUS-GBD with LAMS and 3-year follow-up or until death were included in this study. No endoscopic revisions were scheduled unless an adverse event (AE) or suspected LAMS dysfunction appeared. AEs occurred in 18%, 20%, and 26% of patients at the 1st, 2nd, and 3rd year, respectively. Thirteen patients developed at least one AE, and 6 presented a second AE during the follow-up. Recurrence of cholecystitis occurred in 2 patients (4%). Seven stent migrations (14%) occurred but all were asymptomatic. Symptomatic LAMS-related AEs (LAMS-RAEs) (37.5%) were related to the gastric location of the stent compared with the duodenal location (66.7% vs. 12.5%, p= 0.03). No stent-related bleeding or stent-related mortality was observed.
Conclusions: EUS-GBD with LAMS without scheduled removal is an effective and safe long-term treatment in high surgical-risk patients with acute cholecystitis. Late LAMS-RAEs tend to be more asymptomatic over time. Symptomatic LAMS-RAEs are associated with gastric location and, overall, AEs tend to recur.