Perelman School of Medicine at the University of Pennsylvania Philadelphia, PA
Nicol Tugarinov, MD1, Andrew Canakis, DO2, Angel Miro-Gonzalez, MD3, Smit Deliwala, MD4, Benjamin Twery, MD5, Shayan S. Irani, MD6, Todd H.. Baron, MD7 1Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; 2Unc chapel hill, Bishopville, MD; 3University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC; 4Emory University School of Medicine, Atlanta, GA; 5University of Maryland School of Medicine, Baltimore, MD; 6Virginia Mason Medical Center, Seattle, WA; 7University of North Carolina at Chapel Hill, Chapel Hill, NC Introduction: Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has emerged as a reliable management option in high-risk surgical patients with acute cholecystitis. While short-term efficacy and safety have been well demonstrated, data on outcomes 1 ≥ year remain limited. The use of lumen-apposing metal stents (LAMS) has enhanced the technical abilities of this approach. Guidelines now support the use of EUS-GBD over percutaneous transhepatic gallbladder drainage in this patient population. In this systematic review and meta-analysis, we aimed to assess the clinical success of individuals treated with EUS-GBD for acute cholecystitis, with a follow-up period ≥ 1 year. Methods: A comprehensive literature search was performed across Medline, Embase, Scopus, and the Cochrane Library from inception through April 2025. Studies reporting clinical outcomes of EUS-GBD for acute cholecystitis in adults with ≥1 year of follow-up were included. Primary outcomes were technical and clinical success. Secondary outcomes included rates of cholecystitis recurrence, readmission, reintervention, stent patency, and adverse events (AEs). Results: Eighteen studies met inclusion criteria (n= 701 patients). Details regarding study characteristic are detailed in Table 1. The pooled technical success rate was 95.8% (95% CI, 93.9–97.2; I²=0%) and clinical success rate was 94.3% (95% CI, 92–96; I²=0%). Cholecystitis recurrence ≥ 1 year after the procedure was 4.2% (95% CI, 2.8–6.2). Readmission occurred in 19% of patients (95% CI, 8.9–36; I²=66%) and reintervention was required in 6% (95% CI, 3.6–9.8; I²=0%). The need for repeat endoscopy due to stent occlusion was 2.9% (95% CI, 1.5–5.6), and pooled stent patency was 418.8 days (95% CI, 98.3–739.3). Adverse events included abdominal pain (4.4%), immediate bleeding (4.0%), delayed bleeding (5.1%), perforation (2.1%), and pneumoperitoneum (3.9%). Discussion: This study demonstrates that EUS-GBD is a technically effective and clinically durable treatment modality for acute cholecystitis with ≥ 1 year follow up duration. There was a sustained clinical success rate with low recurrence and reintervention beyond one year. The overall low rate of AEs associated with EUS-GBD reflects its unique ability to care for those considered high risk for surgery. These findings reinforce the growing role of EUS-GBD as a first-line modality in non-operative candidates. Further prospective studies are needed to standardize post-procedural management and evaluate long-term stent strategies.
Figure: Figure 1: The pooled technical success and clinical success of the included studies.
Figure: Table 1: Included study characteristics.
Disclosures: Nicol Tugarinov indicated no relevant financial relationships. Andrew Canakis indicated no relevant financial relationships. Angel Miro-Gonzalez indicated no relevant financial relationships. Smit Deliwala indicated no relevant financial relationships. Benjamin Twery indicated no relevant financial relationships. Shayan Irani: Boston Scientific – Consultant. ConMed – Consultant. W.L. Gore – Consultant. Todd Baron: Boston Scientific – Consultant. Cook Endoscopy – Consultant. Olympus America – Consultant. W.L. Gore – Consultant.
Nicol Tugarinov, MD1, Andrew Canakis, DO2, Angel Miro-Gonzalez, MD3, Smit Deliwala, MD4, Benjamin Twery, MD5, Shayan S. Irani, MD6, Todd H.. Baron, MD7. P1400 - Clinical Outcomes (≥1 Year) of EUS-Guided Gallbladder Drainage in Patients With Acute Cholecystitis: A Systematic Review and Meta-Analysis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
