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.