AGA Clinical Practice Update on Role of EUS-Guided Gallbladder Drainage in Acute Cholecystitis: Commentary

DESCRIPTION: Endoscopic gallbladder drainage is a feasible and efficacious alternative to percutaneous drainage in the management of acute cholecystitis for high-risk surgical candidates. Endoscopic ultrasound- guided gallbladder drainage and per-oral cholecystoscopy is facilitated by the use of lumen-apposing metal stents. Endoscopic ultrasound-guided gallbladder drainage should be performed by those expert in advanced therapeutic endoscopic ultrasound. Multidisciplinary collaboration between interventional radiology and surgery is paramount in the care of these patients. Choosing the optimal drainage method is dependent on individual patient characteristics.METHODS: This commentary was drawn from a review of the literature to provide practical advice. Because this was not a systematic review, we did not perform any formal rating of the quality of evidence or strength of the presented considerations. This expert commentary was commis-sioned and approved by the American Gastroenterological Association (AGA) Institute Clinical Practice Updates Committee and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership, and underwent internal peer-review by the Clinical Practice Updates Committee and external peer-review through standard pro-cedures of Clinical Gastroenterology and Hepatology.

Automated summary

Endoscopic gallbladder drainage is a feasible and efficacious alternative to percutaneous drainage for high-risk surgical candidates with acute cholecystitis. The use of lumen-apposing metal stents enables endoscopic ultrasound-guided gallbladder drainage and per-oral cholecystoscopy. Expertise in advanced therapeutic endoscopic ultrasound is necessary for performing this procedure. Multidisciplinary collaboration between interventional radiology and surgery is crucial for the care of these patients. The choice of drainage method depends on individual patient characteristics.