ArticleDEN open2027
Initial Experience With Endoscopic Ultrasound-Guided Gallbladder Drainage Using Lumen-apposing Metal Stents in Extremely Elderly and Frail Patients.
Article in DEN open, 2027. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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17 authors.
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Abstract
Objectives: Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using lumen-apposing metal stents (LAMS) is a treatment option for acute cholecystitis in high-risk surgical patients. However, data on extremely elderly and frail patients are limited. We report our initial experience with EUS-GBD using electrocautery-enhanced LAMS in this population after reimbursement approval in Japan. Methods: We retrospectively analyzed consecutive patients who underwent EUS-GBD using electrocautery-enhanced LAMS for acute cholecystitis at a single center after reimbursement approval in June 2025. Results: Ten patients (median age, 90 years; median Clinical Frailty Scale score, 7) underwent EUS-GBD. All procedures were performed via a transduodenal approach using a 10-mm LAMS. Technical success was achieved in all patients. Clinical success was achieved in nine of the 10 patients (90%); one patient with Grade III cholecystitis complicated by severe pneumonia and heart failure died on postoperative day 1 before clinical assessment. The median stent deployment time was 3.5 min, and the median total procedure time was 16 min. Cholecystoscopy through the LAMS using a slim endoscope was feasible when required. Conclusion: In this pilot study, EUS-GBD using electrocautery-enhanced LAMS was technically successful in extremely elderly and frail patients. Although short-term outcomes appeared acceptable in most patients, the single POD1 death underscores the importance of careful patient selection. These preliminary findings require validation in larger studies. Trial Registration: N/A.
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