Endoscopic Ultrasound-Guided Gallbladder Drainage: Current Perspectives

Figures & data

Figure 1 Acute cholecystitis (AC) with distended gallbladder, stones, mucosal hyper-enhancement and pericholecystic fluid noted on computed tomography (CT) scan.

Figure 2 Graphic representation of the main interventional technique applied to perform gallbladder drainage in patients with acute cholecystitis (AC); (A) percutaneous transhepatic gallbladder drainage (PTGBD); (B) endoscopic transpapillary gallbladder drainage (ETGBD); (C) endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) with electro cautery lumen-apposing metal stent (EC-LAMS).

Table 1 Available Lumen Apposing Metal and Biflanged Stents

Stent Type	Diameter & Length (mm)
Lumen Apposing Metal Stents (LAMS)
AXIOS (Boston Scientific, Malborough, Massachusetts, USA) Hot Axios(electrocautery-enhanced) Cold-Axios(non-electrocautery-enhanced)	6 x 8
	8 x 8
	10 x 10
	15 x 10
	20 x 10
SPAXUS (Taewoong Medical, Gyeonggi-do, South Korea)	8 x 20
	10 x 20
	16 x 20
Biflanged Metal Stents
NAGI (Taewoong Medical, Gyeonggi-do, South Korea)	10 x 10/20/30
	12 x 10/20/30
	14 x 10/20/30
	16 x 10/20/30
AIX PPS (Leufen Medical, Aachen, Germany)	10 x 10/20/30
	15 x 30
Hanaro Stent Biliary (M.I.Tech, Seoul, South Korea)	10 x 30/40
	12 x 30/40

Abbreviations: USA, United States of America; LAMS, lumen-apposing metal stent.

Figure 3 Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) with first flange opening of the electrocautery lumen-apposing metal stent (EC-LAMS).

Figure 4 Endoscopic image obtained after electrocautery lumen-apposing metal stent (EC-LAMS) deployment in the gastric lumen.

Figure 5 Fluoroscopic view of newly positioned electrocautery lumen-apposing metal stent (EC-LAMS) into the gallbladder lumen.

Figure 6 Computed tomography (CT) scan after 2 months of follow-up showing a cholecystoduodenostomy using electrocautery lumen-apposing metal stent (EC-LAMS).

Table 2 Comparison Between EUS-GBD and PTGBD

Author	Year	Number of Patients	Technical Success (%)		Clinical Success (%)		Adverse Events (%)
			EUS-GBD	PTGBD	EUS-GBD	PTGBD	EUS-GBD	PTGBD
Jang et al^Citation21	2012	59	97	97	100	96	7	3
Kedia et al^Citation22	2015	73	97.6	100	97.6	86.7	13.3	39.5
Teoh et al^Citation10	2016	118	96.6	100	89.8	94.9	32.2	74.6
Irani et al^Citation23	2017	90	98	100	96	91	11	32
Tyberg et al^Citation9	2018	155	95	99	95	86	21.4	21.2

Abbreviations: EUS-GBD, endoscopic ultrasound-guided gallbladder drainage; PTGBD, percutaneous transhepatic gallbladder drainage.

Figure 7 Fluoroscopic view of a conversion procedure, from percutaneous transhepatic gallbladder drainage (PTGBD) to endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) with the positioned electrocautery lumen apposing metal stent (EC-LAMS) into the gallbladder lumen.

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