Endoscopic ultrasound in the management of acute cholecystitis: Practical review

Abstract

Endoscopic ultrasound‐guided gallbladder drainage (EUS‐GBD) has emerged over the last years as an alternative procedure to percutaneous drainage (PT)‐GBD in patients with acute cholecystitis (AC) at high surgical risk. This process has been driven by the advent of lumen‐apposing metal stents (LAMS) with electrocautery‐enhanced capability, which has rendered the drainage procedure easier to accomplish and safer. Studies and meta‐analyses have proven the superiority of EUS‐GBD over PT‐GBD in high‐surgical‐risk patients with AC. Little evidence exists in the same setting that EUS‐GBD compares equally with laparoscopic cholecystectomy (LC). Moreover, EUS‐GBD might theoretically have a possible role in patients at high surgical risk with an indication to undergo cholecystectomy or with a high probability of conversion from LC to open cholecystectomy. Properly designed studies are needed to better clarify the role of EUS‐GBD in these patient populations.