Search Results (31)

Background/Objectives: Acute cholecystitis in patients with malignant biliary obstruction (MBO) is challenging to manage. Evidence for endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using double-pigtail plastic stents (DPPS) in this setting remains limited. We evaluated the efficacy and safety of EUS-GBD using DPPS for acute cholecystitis in patients with MBO. Methods: We retrospectively reviewed 41 consecutive patients who underwent EUS-GBD using DPPS at two centers. The primary endpoint was technical success; secondary endpoints included clinical success, adverse events, recurrence, and subsequent oncologic treatment. Results: Technical success was achieved in 95.1% (39/41), with clinical success in all technically successful cases. Adverse events included biliary peritonitis (14.6%) and procedure-related DPPS migration (2.4%). Recurrence occurred in 2.6% of patients. Systemic therapy was resumed in 10 of 18 patients (55.6%) at a median of 15 days after EUS-GBD. Conclusions: EUS-GBD using DPPS achieved high technical and clinical success rates with a low recurrence rate in selected patients with acute cholecystitis and MBO. Systemic therapy could be resumed in a subset of patients following successful drainage. These findings suggest that DPPS-based EUS-GBD may be a feasible internal drainage option in this setting, although prospective comparative studies are needed to further establish its safety and effectiveness. Full article

Background: Acute cholecystitis (AC) is a common inflammatory disease of the gallbladder. Although laparoscopic cholecystectomy remains the standard treatment, gallbladder drainage may be required in patients who are unsuitable for early surgery. Endoscopic transpapillary gallbladder drainage (ETGBD), including endoscopic nasogallbladder drainage (ENGBD) and endoscopic gallbladder stenting (EGBS), has increasingly been used as a minimally invasive internal drainage approach. Aims: This review aims to clarify the role of ETGBD in AC by integrating stepwise technical failure analysis with a practical selection framework among other drainage techniques. Methods: This narrative review was conducted through a structured literature search of PubMed, Embase, Web of Science, and the Cochrane Library up to 30 April 2026. Results: ETGBD preserves native gallbladder anatomy and may have specific value in selected patients, particularly when gallbladder preservation is desirable or concomitant endoscopic retrograde cholangiopancreatography (ERCP) is indicated. Recent technical developments, including cholangioscopy and advanced drainage devices, may support procedural planning and clinical management in selected difficult cases. Compared with percutaneous transhepatic gallbladder drainage (PTGBD) or endoscopic ultrasound-guided gallbladder drainage (EUS-GBD), ETGBD should be regarded as a complementary option rather than a universal substitute, and its application remains limited by variable technical success, cystic duct anatomy, operator expertise, and center experience. However, ETGBD may also be combined with other techniques, providing additional options in selected complex clinical scenarios. Conclusions: Adequately powered multicenter comparative studies with standardized outcome definitions are needed to clarify the optimal role, safety, recurrence risk, and long-term stent management of ETGBD. Full article

Acute cholecystitis (AC) is one of the most prevalent gastrointestinal emergencies, with laparoscopic cholecystectomy representing the definitive treatment per current guidelines. However, a substantial proportion of patients—particularly elderly individuals with major comorbidities, multiorgan dysfunction, or advanced malignancy—are considered poor surgical candidates in whom operative intervention carries prohibitive risk. Although percutaneous transhepatic gallbladder drainage (PT-GBD) has traditionally served as the first-line non-surgical alternative, its significant morbidity and technical limitations in patients with coagulopathy, massive ascites, or an unsafe percutaneous window have driven the development of endoscopic drainage modalities. This review critically appraises the comparative evidence for two endoscopic gallbladder drainage strategies: endoscopic transpapillary gallbladder drainage (ET-GBD), performed via endoscopic retrograde cholangiopancreatography, and endoscopic ultrasound-guided gallbladder drainage (EUS-GBD), most commonly using lumen-apposing metal stents (LAMS). In appropriately selected high-risk surgical candidates, EUS-GBD with LAMS has emerged as a preferred endoscopic option, supported by high technical success rates, low recurrent AC rates, AGA expert guidance, and FDA regulatory reclassification of the AXIOS stent for gallbladder drainage. Nevertheless, ET-GBD retains distinct clinical indications, including concurrent biliary intervention, large-volume ascites, high bleeding risk, anticipated surgical candidacy, and resource-limited settings. Optimal management requires a systematic, algorithm-driven multidisciplinary approach integrating comorbidity profile, biliary anatomy, cystic duct patency, and institutional expertise. Full article

Background/Objectives: Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) with Lumen-Apposing Metal Stent (LAMS) is an established option for high-surgical-risk patients, with high technical and clinical success. Indications include acute cholecystitis and palliation of jaundice in malignant distal biliary obstruction (MDBO). Both trans-gastric and trans-duodenal approaches are used, but the optimal route remains debated. The aim of the study was to compare trans-gastric and trans-duodenal access in terms of technical success, adverse events, readmissions, and reinterventions. Methods: We implemented a single-centre retrospective study of consecutive EUS-GBD procedures with LAMS at a tertiary endoscopy unit (January 2020–January 2026). Demographic, clinical, and procedural data were analyzed using appropriate statistical tests. Results: Seventy patients were included (51.4% male; mean age 77 ± 12 years). Indications were acute cholecystitis (64.3%) and MDBO (35.7%). Trans-gastric access was used in 48.5% of cases. A Hot-Axios LAMS was deployed in 77.2% of cases, mostly >10 mm. Technical success was achieved in 98.5% of cases. Naso-cystic drainage (NCD) was used through the LAMS in 47.1% of patients, while a double pig-tail plastic stent was used in 7.2% of patients. Adverse events were rare (1.4% misdeployment). LAMS obstruction occurred in 10% of patients, with reintervention required in 12.8% of patients. No differences were found between access routes in indication, technical success, LAMS type/size, or adjunctive drainage. However, trans-gastric access was associated with a higher reintervention rate (p = 0.01). Conclusions: EUS-GBD is a safe and effective procedure. While both approaches are comparable in most outcomes, the trans-gastric route may carry a higher risk of reintervention and should be avoided when alternative access is feasible. Full article

Background/Objectives: Laparoscopic cholecystectomy (LC) is the current gold standard in patients with acute cholecystitis. Percutaneous cholecystostomy (PC) remains an option for those who are not surgical candidates but is associated with adverse effects. We studied technical success and patient satisfaction for endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) after initially receiving a PC drain. Methods: A multi-center study was conducted at 4 institutions involving patients who initially received a PC. These patients were given the option to transition to receive EUS-GBD. A 5-point Likert scale was used to assess patient satisfaction comparing PC vs. EUS-GBD. Demographic data, including age, sex, reason for PC, complications, and patient satisfaction scores, were collected. Result: All seven patients who underwent percutaneous cholecystostomy rated their experience as 1 (very dissatisfied), whereas the same patients rated EUS-guided gallbladder drainage with a mean satisfaction score of 4.7 (very satisfied). Conclusions: EUS-GBD is effective and offers higher satisfaction scores in patients who are not surgical candidates. Full article

Background/Objectives: Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is a minimally invasive alternative for managing acute cholecystitis in patients who are unsuitable for surgery. Although its short-term efficacy is well-established, its long-term outcomes, especially in patients with malignancy-associated cholecystitis, remain unclear. Methods: This multicenter, retrospective study included 139 patients who underwent EUS-GBD with a plastic stent for inoperable acute cholecystitis between January 2010 and October 2023. Patients were divided into two groups: a malignant group (n = 60) with cystic duct obstruction caused by cancer invasion or self-expandable metal stents, and a benign group (n = 79) with calculous or acalculous cholecystitis. The outcomes assessed included cholecystitis recurrence, time to recurrence, adverse events, and risk factors for recurrence. Results: Technical success was achieved in all patients, with an overall clinical success rate of 94.6%. Cholecystitis recurred significantly more frequently in the malignant group than in the benign group (13.3% vs. 2.5%; p = 0.015). Univariate analysis identified malignancy as a significant risk factor of recurrence (odds ratio, 5.92; p = 0.028). Conclusions: EUS-GBD is a safe and effective long-term treatment for cholecystitis in non-surgical candidates. However, malignancy-associated cholecystitis carries a high risk of recurrence, warranting careful follow-up and individualized management. Full article

Interventional endoscopic ultrasound (EUS) has become a cornerstone in the management of malignant pancreatobiliary diseases, offering minimally invasive alternatives to traditional surgical approaches. More recently, accumulating evidence supports its expanding role in the treatment of benign pancreatobiliary conditions, including acute cholecystitis and pancreatitis, benign gastric outlet obstruction, and scenarios involving altered gastrointestinal anatomy. This narrative review provides an overview of key EUS-guided drainage techniques utilizing lumen-apposing metal stents (LAMSs) in benign settings. It focuses on procedures such as EUS-guided gallbladder drainage, drainage of abdominal collections, EUS-directed transgastric ERCP (EDGE), and EUS-gastroenterostomy. These interventions have demonstrated high technical and clinical success rates, favorable safety profiles, and expanding indications, particularly among patients who are poor surgical candidates. This review highlights evolving techniques, clinical outcomes, and the impact of device innovations on procedural efficacy and safety. Full article

Background and Objectives: Bile leak is a common complication after hepatopancreatobiliary surgery, requiring timely management to prevent life-threatening outcomes. Endoscopic retrograde cholangiopancreatography (ERCP) is essential in treatment, but large data concerning optimal timing and technique selection are unavailable. This study evaluates whether the timing of ERCP influences healing and if different bile duct injuries affect outcomes. Materials and Methods: Data from a prospectively maintained database over 25 years (2001–2025) included 176 patients (M/F: 91/85, mean age 62) undergoing ERCP for bile leaks. Results: Most leaks followed cholecystectomy (n = 143, 81.5%). The median time from leak to ERCP was 7 days. Ten patients (5.7%) had complete common bile duct (CBD) transection—considered major leaks—requiring surgery. Among the 166 minor leaks, the cystic duct stump (40.1%) was the most common injury site, followed by the CBD (24.1%) and the gallbladder bed (15.4%). Healing occurred in 90.6%. Stent placement improved healing rates (93.9% vs. 75.9%, p = 0.007), with no difference between pig-tail and (Amsterdam) straight plastic stents (90% vs. 96%, p = 0.267). Retained CBD stones or CBD strictures did not affect outcomes. Leaks from the cystic duct stump had a 96.9% resolution rate, whereas gallbladder bed leaks healed in 88%. The median healing time was 2 days, unaffected by stent placement or ES alone (p = 0.842), but later ERCP correlated with longer healing (RR: 0.362, p < 0.001). Following a right aberrant bile leak, the time for healing was longer than in leaks from other sites. Conclusions: ERCP with stenting remains the first-line approach for minor bile leaks. Early ERCP accelerates healing, emphasizing the importance of prompt intervention. Full article

Acute cholecystitis in patients unfit for surgery presents a significant therapeutic challenge, often requiring alternatives to traditional cholecystectomy. In recent years, endoscopic ultrasound (EUS)-guided gallbladder drainage using Lumen-Apposing Metal Stents (LAMSs) has emerged as a promising minimally invasive approach. This umbrella review synthesizes evidence from existing systematic reviews and meta-analyses evaluating the efficacy and safety of EUS-guided gallbladder drainage with LAMSs in high-surgical-risk patients. The pooled data demonstrate that this approach provides effective symptomatic relief, with high technical and clinical success rates and a low incidence of adverse events. The use of EUS allows real-time visualization and precise access to the gallbladder, contributing to the safety and efficacy of the procedure. These results reinforce the expanding role of endoscopic techniques in managing complex biliary conditions, suggesting that the use of diagnostic EUS in combination with LAMS placement can lead to a significant reduction in the need for surgical intervention among frail patients. Full article

The indications for biliary drainage in cases of pancreatic head tumors with biliary obstruction are well established. ERCP with stent placement has long been the gold standard technique, outperforming surgery or percutaneous drainage. However, in cases of distal malignant biliary obstruction, ERCP becomes more complex, increasing the risk of complications. The advent of therapeutic endoscopic ultrasound (EUS), particularly EUS–choledochoduodenostomy (EUS-CDS) and EUS–hepaticogastrostomy (EUS-HGS), has transformed the management of distal malignant biliary obstruction in the case of pancreatic cancer. EUS-CDS creates communication between the duodenum and the common bile duct. Lumen-apposing metal stents (LAMSs) simplify the procedure, offering high technical and clinical success rates and making the technique easier to perform. Nevertheless, long-term dysfunction rates remain high, necessitating careful definition of procedural indications. EUS-HGS, a more complex technique, connects dilated left bile ducts to the stomach and requires advanced expertise; it is associated with a higher rate of complications. However, its clinical efficacy and technical success are comparable to those of EUS-CDS, and it is the preferred technique in cases of duodenal obstruction or altered anatomy. European and American guidelines currently position EUS-guided biliary drainage (EUS-BD) as a second-line approach after ERCP failure or when ERCP is not feasible, but there is a growing trend toward earlier use. Other techniques are emerging, such as EUS-guided gallbladder drainage (EUS-GBD) and combining EUS-HGS with antegrade stenting, offering valuable alternatives when conventional techniques fail or are inaccessible. Full article

Background/Objectives: Cholecystectomy remains the gold-standard treatment for acute cholecystitis. However, in patients deemed unfit for surgery, alternative gallbladder drainage techniques are required. These include percutaneous gallbladder drainage (PT-GBD), endoscopic transpapillary gallbladder drainage (ET-GBD), and the more recently adopted endoscopic ultrasound-guided gallbladder drainage (EUS-GBD). EUS-GBD has emerged as a promising minimally invasive option, offering high technical and clinical success with fewer complications and need for reinterventions. The objective of this study was to evaluate the clinical outcomes of EUS-GBD in high-risk surgical patients with acute cholecystitis. Methods: We conducted a single-center retrospective study evaluating outcomes of EUS-GBD in a tertiary referral center in Ireland. Data from ten high-risk patients with acute cholecystitis who underwent EUS-GBD using a 15 mm × 10 mm HOT AXIOS lumen-apposing metal stent (LAMS) between October 2017 and September 2018 were analyzed. Parameters assessed included technical and clinical success, adverse events, and 1-year mortality. Results: The mean age of patients was 79.5 years (range 65–95). Technical success of stent placement was achieved in all patients with no immediate complications. A trans-gastric approach was used in 7 patients while a trans-duodenal route was employed in the remaining 3. 1–year mortality following EUS-GBD was 20%. Stents were not removed in any patient in this series. No patient experienced stent-related adverse events, re-occurrence of cholecystitis, or the need for re-intervention. Conclusions: EUS-GBD has very high technical and clinical success rates, with low risk of complications and need for re-intervention in comparison to other options of GB decompression. It is, however, not widely available, and it requires a skilled endoscopist with experience in interventional EUS. Full article

Background: Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) remains the most frequent and clinically significant complication of ERCP, with a multifactorial etiology involving patient- and procedure-related risk factors. Despite preventive measures such as NSAIDs and peri-procedural stenting, the incidence of PEP has not substantially declined. We aimed to assess clinical determinants of PEP in a large real-world cohort treated with standardized procedural protocols. Materials and Methods: This retrospective single-center study analyzed 806 patients who underwent ERCP between January 2019 and December 2021. All procedures were performed by a single operator under general anesthesia with standardized prophylaxis (diclofenac 100 mg per rectum and cefazolin 2 g intravenously). Patients with delayed ERCP (>48 h from admission) or active acute pancreatitis were excluded. Logistic regression was used to identify independent predictors of PEP, hospital stay, and in-hospital mortality. Results: PEP occurred in 60 patients (7.4%). Independent risk factors included stenosis of the papilla of Vater (OR = 2.45; p = 0.025), gallbladder stones (OR = 2.66; p = 0.001), prior acute pancreatitis (OR = 2.72; p = 0.005), and sphincterotomy (OR = 2.53; p = 0.016). PEP was associated with longer hospitalization (MD = 4.5 days; p < 0.001) and increased in-hospital mortality (6.7% vs. 1.7%; p = 0.032). Conclusion: Stenosis of the papilla, gallbladder stones, prior acute pancreatitis, and sphincterotomy independently increased the risk of PEP, whereas older age, previous ERCP, and pancreaticoduodenal tumors were associated with a reduced risk. Despite standardized prophylaxis, PEP remains a relevant clinical concern. Identification of high-risk patients and individualized procedural planning are essential to minimizing complications. Full article

Objective: Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has emerged as a promising alternative for biliary decompression in patients with malignant distal biliary obstruction (MDBO), used either as a first-line approach or after other interventions have failed. This study aimed to evaluate the aggregated efficacy and safety of EUS-GBD in this patient population. Methods: A comprehensive literature search was carried out across PubMed/Medline, Embase, and Cochrane databases up to 9 January 2024, to identify studies reporting outcomes of EUS-GBD in MDBO cases. The primary endpoint assessed was clinical success, while secondary endpoints included technical success and the incidence of adverse events (AEs). Pooled outcomes were calculated using a random-effects model and presented with 95% confidence intervals (CIs). Results: Seven studies encompassing a total of 193 patients were included in the analysis. The combined clinical success rate for EUS-GBD was 88.1% [95% CI: 78.9–94.9%], while the technical success rate was 99.2% [95% CI: 97.5–100%]. The overall AE rate was 13.7% [95% CI: 9.3–18.8%], with the majority being mild to moderate in severity; no fatal complications were reported. Subgroup analyses indicated that use of smaller lumen-apposing metal stents (LAMS) (<15 mm) was associated with slightly higher clinical success (93.3% [95% CI: 72.4–99.9%]) compared to larger stents (≥15 mm) (87.1% [95% CI: 78.8–93.5%]), and a marginally lower rate of AEs (12.3% [95% CI: 6.4–19.7%] vs. 15.2% [95% CI: 6.5–26.6%]). Conclusions: EUS-GBD demonstrates excellent technical performance, high clinical efficacy, and a manageable safety profile in patients with MDBO and a patent cystic duct. Full article

Endoscopic management of benign pancreaticobiliary disorders encompasses a range of procedures designed to address complications in gallstone disease, choledocholithiasis, and pancreatic disorders. Acute cholecystitis is typically treated with cholecystectomy or percutaneous drainage (PT-GBD), but for high-risk or future surgical candidates, alternative decompression methods, such as endoscopic transpapillary gallbladder drainage (ETP-GBD), and endoscopic ultrasound (EUS)-guided gallbladder drainage (EUS-GBD), are effective. PT-GBD is associated with significant discomfort as well as variable adverse event rates. EUS-GBD leverages lumen-apposing metal stents (LAMS) for direct access to the gallbladder, providing the ability to treat an inflamed GB internally. Choledocholithiasis is primarily managed with ERCP, utilizing techniques to include balloon extraction, mechanical lithotripsy, or advanced methods such as electrohydraulic or laser lithotripsy in cases of complex stones. Altered anatomy from bariatric procedures like Roux-en-Y gastric bypass may necessitate specialized approaches, including balloon-assisted ERCP or EUS-directed transgastric ERCP (EDGE). Post-operative complications, including bile leaks and strictures, are managed endoscopically using sphincterotomy and stenting. Post-liver transplant anastomotic and non-anastomotic strictures often require repeated stent placements or advanced techniques like magnetic compression anastomosis in refractory cases. In chronic pancreatitis (CP), endoscopic approaches aim to relieve pain and address structural complications like pancreatic duct (PD) strictures and calculi. ERCP with sphincterotomy and stenting, along with extracorporeal shock wave lithotripsy (ESWL), achieves effective ductal clearance for PD stones. When traditional approaches are insufficient, direct visualization with peroral pancreatoscopy-assisted lithotripsy is utilized. EUS-guided interventions, such as cystgastrostomy, pancreaticogastrostomy, and celiac plexus blockade, offer alternative therapeutic options for pain management and drainage of peripancreatic fluid collections. EUS plays a diagnostic and therapeutic role in CP, with procedures tailored for high-risk patients or those with complex anatomy. As techniques evolve, endoscopic management provides minimally invasive alternatives for patients with complex benign pancreaticobiliary conditions, offering high clinical success and fewer complications. Full article

Endoscopic ultrasound (EUS)-guided interventions have revolutionized the management of malignant biliary obstruction (MBO) and gastric outlet obstruction (GOO), providing minimally invasive alternatives with improved outcomes. These procedures have significantly reduced the need for high-risk surgical interventions or percutaneous alternatives and have provided effective palliative care for patients with advanced gastrointestinal and bilio-pancreatic malignancies. EUS-guided biliary drainage (EUS-BD) techniques, including hepaticogastrostomy (EUS-HGS), choledochoduodenostomy (EUS-CDS), and antegrade stenting (EUS-AS), offer high technical and clinical success rates, with a good safety profile particularly when Endoscopic Retrograde Cholangiopancreatography (ERCP) is not feasible. EUS-HGS, which allows biliary drainage by trans-gastric route, is primarily used for proximal stenosis or in case of surgically altered anatomy; EUS-CDS with Lumen-Apposing Metal Stent (LAMS) for distal MBO (dMBO), EUS-AS as an alternative of EUS-HGS in the bridge-to-surgery scenario or when retrograde access is not possible and EUS-guided gallbladder drainage (EUS-GBD) with LAMS in case of dMBO with cystic duct patent without dilation of common bile duct (CDB). EUS-guided gastroenterostomy (EUS-GE) has already established its role as an effective alternative to surgical GE and enteral self-expandable metal stent, providing relief from GOO with fewer complications and faster recovery times. However, we do not yet have strong evidence on how to combine the different EUS-guided drainage techniques with EUS-GE in the setting of double obstruction. This comprehensive review aims to synthesize growing evidence on this topic by randomized controlled trials, cohort studies, and case series not only to summarize the efficacy, safety, and technical aspects of these procedures but also to propose a treatment algorithm based essentially on the anatomy and stage of the neoplasm to guide clinical decision-making, incorporating the principles of personalized medicine. This review also highlights the transformative impact of EUS-guided interventions on the treatment landscape for MBO and GOO. These techniques offer safer and more effective options than traditional approaches, with the potential for widespread clinical adoption. Further research is needed to refine these procedures, expand their applications, and improve patient care and quality of life. Full article