EUS-Guided Gallbladder Drainage

  • Sunil Amin
  • Amrita SethiEmail author


High-risk non-surgical candidates with acute cholecystitis are traditionally treated with the placement of a percutaneous cholecystostomy tube. However, in recent years, transmural gallbladder drainage via an endoscopic ultrasound-guided approach (EUS-GBD) has emerged as a feasible and potential equally efficacious option that obviates the need for an external drainage catheter. Among expert endoscopists, technical and clinical success rates for EUS-GBD are greater than 90% with similar adverse event rates to percutaneous drainage. Early adopters of EUS-GBD used plastic or fully covered metal self-expandable metal biliary stents (FCSEMS), but more recently, the use of a lumen-apposing metal stent (LAMS) has become widespread due to ease of deployment and lower concern for biliary leakage. Furthermore, LAMS provides continued access to the gallbladder for cholecystoscopy or other advanced interventions such as stone removal. Nevertheless, EUS-GBD remains a relatively new procedure and optimal techniques and best practices are still being defined. As such, endoscopists have yet to reach consensus on issues such as optimal location of drainage (transgastric vs. transduodenal), ideal duration for stents to be left in, and whether patients should receive routine cholecystectomy after resolution of symptoms. Until prospective trials address these issues, EUS-GBD should only be reserved for carefully selected patients in tertiary care centers.


Endoscopic ultrasonography Acute cholecystitis EUS-GB Lumen-apposing metal stent Drainage Percutaneous 

Supplementary material

Video 4.1

Narrated video demonstrating EUS-guided GBD with 15 mm ECE-AXIOS stent using free-hand technique. Courtesy of Mouen Khashab, MD (MP4 153938 kb)


  1. 1.
    Glenn F. Cholecystostomy in the high risk patient with biliary tract disease. Ann Surg. 1977;185(2):185–91.CrossRefGoogle Scholar
  2. 2.
    Elyaderani MK, McDowell DE, Gabriele OF. A preliminary report of percutaneous cholecystostomy under ultrasonography and fluoroscopy guidance. J Clin Gastroenterol. 1983;5(3):277–81.CrossRefGoogle Scholar
  3. 3.
    Kozarek RA. Selective cannulation of the cystic duct at time of ERCP. J Clin Gastroenterol. 1984;6(1):37–40.PubMedGoogle Scholar
  4. 4.
    Itoi T, Sofuni A, Itokawa F, Tsuchiya T, Kurihara T, Ishii K, et al. Endoscopic transpapillary gallbladder drainage in patients with acute cholecystitis in whom percutaneous transhepatic approach is contraindicated or anatomically impossible (with video). Gastrointest Endosc. 2008;68(3):455–60.CrossRefGoogle Scholar
  5. 5.
    Irani S, Ngamruengphong S, Teoh A, Will U, Nieto J, Abu Dayyeh BK, et al. Similar efficacies of endoscopic ultrasound gallbladder drainage with a lumen-apposing metal stent versus percutaneous transhepatic gallbladder drainage for acute cholecystitis. Clin Gastroenterol Hepatol. 2017;15(5):738–45.CrossRefGoogle Scholar
  6. 6.
    Peñas-Herrero I, de la Serna-Higuera C, Perez-Miranda M. Endoscopic ultrasound-guided gallbladder drainage for the management of acute cholecystitis (with video). J Hepatobiliary Pancreat Sci. 2015;22(1):35–43.CrossRefGoogle Scholar
  7. 7.
    Dollhopf M, Larghi A, Will U, Rimbaş M, Anderloni A, Sanchez-Yague A, et al. EUS-guided gallbladder drainage in patients with acute cholecystitis and high surgical risk using an electrocautery-enhanced lumen-apposing metal stent device. Gastrointest Endosc. 2017;86(4):636–43.CrossRefGoogle Scholar
  8. 8.
    Itoi T, Binmoeller KF, Shah J, Sofuni A, Itokawa F, Kurihara T, et al. Clinical evaluation of a novel lumen-apposing metal stent for endosonography-guided pancreatic pseudocyst and gallbladder drainage (with videos). Gastrointest Endosc. 2012;75(4):870–6.CrossRefGoogle Scholar
  9. 9.
    Mori Y, Itoi T, Baron TH, Takada T, Strasberg SM, Pitt HA, et al. TG18 management strategies for gallbladder drainage in patients with acute cholecystitis: updated Tokyo guidelines 2018 (with videos). J Hepatobiliary Pancreat Sci. 2017;25:87.CrossRefGoogle Scholar
  10. 10.
    Takada T, Strasberg SM, Solomkin JS, Pitt HA, Gomi H, Yoshida M, et al. TG13: updated Tokyo guidelines for the management of acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2013;20(1):1–7.CrossRefGoogle Scholar
  11. 11.
    Dimou FM, Adhikari D, Mehta HB, Riall TS. Outcomes in older patients with grade III cholecystitis and cholecystostomy tube placement: a propensity score analysis. J Am Coll Surg. 2017;224(4):502–511.e1.CrossRefGoogle Scholar
  12. 12.
    Itoi T, Baron TH, Mouen K, Tsuchiya T, Irani S, Dhir V, et al. Technical review of EUS-guided gastroenterostomy in 2017. Dig Endosc. 2017;29(4):495–502.Google Scholar
  13. 13.
    Itoi T, Ishii K, Ikeuchi N, Sofuni A, Gotoda T, Moriyasu F, et al. Prospective evaluation of endoscopic ultrasonography-guided double-balloon-occluded gastrojejunostomy bypass (EPASS) for malignant gastric outlet obstruction. Gut. 2016;65(2):193–5.CrossRefGoogle Scholar
  14. 14.
    Anderloni A, Buda A, Vieceli F, Khashab MA, Hassan C, Repici A. Endoscopic ultrasound-guided transmural stenting for gallbladder drainage in high-risk patients with acute cholecystitis: a systematic review and pooled analysis. Surg Endosc. 2016;30(12):5200–8.CrossRefGoogle Scholar
  15. 15.
    Han D, Inamdar S, Lee CW, Miller LS, Trindade AJ, Sejpal DV. Lumen apposing metal stents (LAMSs) for drainage of pancreatic and gallbladder collections: a meta-analysis. J Clin Gastroenterol. 2017. Oct 9.Google Scholar
  16. 16.
    Tyberg A, Saumoy M, Sequeiros EV, Giovannini M, Artifon E, Teoh A, et al. EUS-guided versus percutaneous gallbladder drainage: isn’t it time to convert? J Clin Gastroenterol. 2016;52(1):79–84.Google Scholar
  17. 17.
    Teoh AYB, Serna C, Penas I, Chong CCN, Perez-Miranda M, Ng EKW, et al. Endoscopic ultrasound-guided gallbladder drainage reduces adverse events compared with percutaneous cholecystostomy in patients who are unfit for cholecystectomy. Endoscopy. 2017;49(2):130–8.PubMedGoogle Scholar
  18. 18.
    Choi JH, Kim HW, Lee J-C, Paik K-H, Seong NJ, Yoon CJ, et al. Percutaneous transhepatic versus EUS-guided gallbladder drainage for malignant cystic duct obstruction. Gastrointest Endosc. 2017;85(2):357–64.CrossRefGoogle Scholar
  19. 19.
    Kedia P, Sharaiha RZ, Kumta NA, Widmer J, Jamal-Kabani A, Weaver K, et al. Endoscopic gallbladder drainage compared with percutaneous drainage. Gastrointest Endosc. 2015;82(6):1031–6.CrossRefGoogle Scholar
  20. 20.
    Kamata K, Takenaka M, Kitano M, Omoto S, Miyata T, Minaga K, et al. Endoscopic ultrasound-guided gallbladder drainage for acute cholecystitis: long-term outcomes after removal of a self-expandable metal stent. World J Gastroenterol. 2017;23(4):661–7.CrossRefGoogle Scholar
  21. 21.
    Kim JJ, Hiotis SP, Sur MD. Gastric reflux into the gallbladder after EUS-guided stenting-letter to the editor regarding “EUS-guided versus percutaneous gallbladder drainage: isn’t it time to convert?” J Clin Gastroenterol. 2017. July 10.Google Scholar
  22. 22.
    Yeung B, Teoh AYB. Endoscopic management of gallbladder stones: can we eliminate cholecystectomy? Curr Gastroenterol Rep. 2016;18(8):42.CrossRefGoogle Scholar
  23. 23.
    Chan SM, Teoh AYB, Yip HC, Wong VWY, Chiu PWY, Ng EKW. Feasibility of per-oral cholecystoscopy and advanced gallbladder interventions after EUS-guided gallbladder stenting (with video). Gastrointest Endosc. 2017;85(6):1225–32.CrossRefGoogle Scholar
  24. 24.
    Teoh AYB, Chan AWH, Chiu PWY, Lau JYW. In vivo appearances of gallbladder carcinoma under magnifying endoscopy and probe-based confocal laser endomicroscopy after endosonographic gallbladder drainage. Endoscopy. 2014;46(Suppl 1 UCTN):E13–4.PubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Division of Gastroenterology and HepatologyVirginia Mason Medical CenterSeattleUSA
  2. 2.Division of Digestive and Liver DiseasesColumbia University Medical CenterNew YorkUSA

Personalised recommendations