Endoscopic ultrasound-guided gallbladder drainage for acute cholecystitis: Should the endoscopic option become the status quo?

Abstract

Acute cholecystitis is a common surgical condition characterised by inflammation of the gallbladder wall, commonly secondary to cystic duct or infundibulum obstruction. The disease can be complicated by infection secondary to translocation of bacteria from the bile duct resulting in significant patient morbidity and potential mortality. The gold standard of treatment is cholecystectomy, however endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has emerged over the past two decades as a minimally invasive technique for gallbladder decompression in patients deemed to be high surgical risk candidates, with reduced surgical interventions, adverse events and unplanned hospital admissions compared to percutaneous gallbladder drainage. The aim of this review is to outline the procedural components of EUS-GBD, the clinical and technical outcomes, complications and future directions.

Keywords: Biliary; Gallbladder; Endoscopy; Cholecystogastrostomy; Cholecystoduodenostomy; Endoscopic ultrasound

Core Tip: Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is a minimally invasive technique that has emerged in the management of acute cholecystitis (AC) with attractive technical and clinical success rates. Increased adoption at a global scale has seen it surpass percutaneous gallbladder drainage given the reduced morbidity associated with the procedure. Although EUS-GBD is limited to those with AC, there is emerging data supporting its use in a range of biliary pathologies including malignant biliary obstruction. Despite its perceived role as a destination therapy, more recent literature has demonstrated that cholecystectomy can be safely and successfully performed post EUS-GBD. With increased adoption of EUS-GBD it is envisioned that it will become standard practice in those in whom cholecystectomy is not deemed an option.