Endoscopic Gallbladder Drainage Techniques for Acute Cholecystitis

Acute cholecystitis, an inflammation of the gallbladder usually due to obstructing gallstones, is conventionally managed by early cholecystectomy. In patients unfit for surgery owing to comorbidities or frailty, gallbladder drainage is vital to control infection and relieve symptoms. Endoscopic approaches have evolved to provide internal drainage, avoiding the discomfort and infection risks of external tubes. Two principal endoscopic techniques are employed: endoscopic transpapillary gallbladder drainage (ETGBD), in which a guidewire and stent are passed into the gallbladder via the cystic duct under endoscopic retrograde cholangiopancreatography guidance; and endoscopic ultrasound-guided gallbladder drainage (EUS-GBD), in which transmural access is created between the gastrointestinal lumen and gallbladder under ultrasound and fluoroscopic control. Stent technology has progressed from plastic pigtail designs to self-expandable metal stents and dedicated lumen-apposing metal stents (LAMS), which facilitate stable tracts and allow cholecystoscopy or lithotripsy through the fistula. Careful patient selection, cystic duct anatomy assessment, and coordination with surgical teams are key to optimising outcomes. Endoscopic drainage serves both as a bridge to delayed surgery and as a long-term solution in those for whom definitive cholecystectomy remains contraindicated.

Research from Nature Portfolio

Recent clinical experience with electrocautery-enhanced lumen-apposing metal stents in high-risk surgical patients has demonstrated technical success rates approaching 95 % and clinical resolution in all cases. Stent deployment under endoscopic ultrasound guidance achieved rapid gallbladder decompression, and long-term follow-up showed sustained patency in the majority of patients. Adverse events were uncommon and manageable, and stent migration or obstruction was addressed by placement of adjunctive pigtail stents. These findings underscore the safety and efficacy of advanced LAMS designs in complex cases and highlight their role in multidisciplinary management of acute cholecystitis.

Endoscopic Gallbladder Drainage Techniques for Acute Cholecystitis publication trend

The graph below shows the total number of articles in endoscopic gallbladder drainage techniques for acute cholecystitis across all publications each year (not limited to Nature Index journals).

Technical terms

Acute cholecystitis: Inflammation of the gallbladder, most often due to obstruction by gallstones, presenting with pain, fever and elevated inflammatory markers.

Endoscopic transpapillary gallbladder drainage (ETGBD): A method of internal gallbladder drainage via the cystic duct by retrograde endoscopic access and stent insertion under ERCP guidance.

Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD): A technique creating a transmural fistula between the gastrointestinal tract and gallbladder under real-time ultrasound and fluoroscopic guidance, followed by stent placement.

Lumen-apposing metal stent (LAMS): A self-expandable metal stent with wide flanges designed to maintain apposition between two luminal structures, facilitating stable drainage and access for further interventions.

Percutaneous transhepatic gallbladder drainage (PT-GBD): An external drainage procedure in which a catheter is inserted through the liver into the gallbladder under imaging guidance, serving as a comparator to endoscopic approaches.

References

1. Revolutionizing outcomes: endoscopic ultrasound-guided gallbladder drainage using innovative electrocautery enhanced-lumen apposing metal stents for high-risk surgical patients. Scientific Reports (2024).
2. Endoscopic Ultrasound-Guided Gallbladder Drainage versus Percutaneous Gallbladder Drainage for Acute Cholecystitis: A Systematic Review and Meta-Analysis. Diagnostics (2023).
3. The Efficacy and Safety of EUS-Guided Gallbladder Drainage as a Bridge to Surgery for Patients with Acute Cholecystitis. Journal of Clinical Medicine (2023).
4. Endoscopic Gallbladder Drainage: A Comprehensive Review on Indications, Techniques, and Future Perspectives. Medicina (2024).