Post written by Umar Hayat, MD, MPH, from Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania, USA.

EUS-guided gallbladder drainage using lumen-apposing metal stents (EUS-GBD-LAMSs) and percutaneous cholecystostomy for gallbladder drainage (PTGBD) are the alternative treatment modalities in high-risk surgical patients with acute cholecystitis (AC). This study aimed to compare the safety of these procedures for AC in surgically suboptimal candidates.

We highlighted the safety and feasibility of EUS-GBD-LAMSs compared with the traditionally used PTGBD approach for this high-risk population. This study underscores the advantages of EUS-GBD-LAMSs over PTGBD in terms of short- and long-term adverse events.

The primary outcomes of interest were the adverse events after each intervention. Adverse events within 4 weeks were defined as early, and adverse events after 4 weeks were described as delayed. Secondary outcomes were the length of hospital stay, follow-up duration, re-intervention rate needed after the initial procedure, recurrent cholecystitis, and hospital readmission rate.

Although PTGBD is the current criterion standard for gallbladder drainage in nonsurgical patients with AC, it is associated with significant adverse events. This study showed that endoscopic gallbladder drainage using LAMSs and PTGBD are equally safe regarding early adverse events. EUS-GBD-LAMSs had a better safety profile than PTGBD with respect to delayed and overall adverse events.

Furthermore, EUS-GBD-LAMSs were associated with a shorter length of hospital stay; a lower rate of recurrent cholecystitis, re-interventions, and hospital readmissions; and a shorter mean postprocedure follow-up duration. These findings make EUS-GBD-LAMSs a potentially superior option for gallbladder drainage in patients with AC.

The pooled odds ratios (ORs) of early, delayed, and overall adverse events (EUSBD-LAMS vs percutaneous cholecystostomy for gallbladder drainage [PTGBD]). CI, Confidence interval; EUSBD-LAMS, EUS-guided gallbladder drainage using lumen-apposing metal stent; REML, restricted maximum likelihood.

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