EUS-guided gallbladder drainage with electrocautery-enhanced lumen-apposing metal stents: a UK and Ireland multicentre collaboration

Objective EUS-guided gallbladder drainage (EUS-GBD) with electrocautery-enhanced lumen-apposing metal stents (EC-LAMS) is an emerging method of establishing GBD in patients with acute cholecystitis lacking fitness for surgery. Robust data on long-term outcomes are lacking. This study assessed the efficacy, safety and durability of this procedure.Design/method Retrospective review of consecutive patients undergoing this procedure at 12 tertiary institutions across the UK and Ireland between January 2016 and May 2023 was undertaken. Primary outcomes included technical success, clinical success (resolution of acute cholecystitis within 96 hours) and adverse event (AE) rates at 30 days, 1 year and 3 years. Secondary outcomes in the cohort with non-malignant cholecystitis included rates of recurrent cholecystitis and further endoscopic procedures for stone extraction and/or stent removal.Results 64 patients (68.8% female) were included. The most common indication was calculous cholecystitis (45%; n=29) and the median follow-up period was 467 days. Technical and clinical success was achieved in 95.3% (n=61) and 94.6% (n=53), respectively. The 30-day AE rate was 4.7% (n=3). A further AE occurred in 15% (n=4), 7.1% (n=1) and 0% (n=0) at 1, 2 and 3 years, respectively, while the unplanned biliary reintervention rate was 0% (n=0), 7% (n=1) and 0% (n=0). Of those with benign disease, the EC-LAMS was removed in 15.0% (n=3) at 1 year, with only one case of recurrent cholecystitis.Conclusions EUS-GBD with EC-LAMS at tertiary institutions is a highly effective and relatively safe technique in patients who are not fit for surgery. Routine stent removal in non-malignant cases does not appear to impact clinical outcome.