Initial Experience With Endoscopic Ultrasound-Guided Gallbladder Drainage Using Lumen-apposing Metal Stents in Extremely Elderly and Frail Patients.
EUS-GBD using electrocautery-enhanced LAMS was technically successful in a small group of extremely elderly and frail patients, but careful patient selection is critical due to associated risks.
Where it sits
this study against the rest of the semax corpusSummary and findings
This study evaluated the technical and clinical success of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using lumen-apposing metal stents (LAMS) in extremely elderly and frail patients. Ten patients with a median age of 90 years underwent the procedure, achieving a technical success rate of 100% and a clinical success rate of 90%. One patient died on postoperative day 1 due to complications.
Abstract
<h4>Objectives</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusion</h4>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.<h4>Trial registration</h4>N/A.
Background
This paper addresses the feasibility of EUS-GBD in extremely elderly and frail patients, a population often at high risk for surgical interventions. Previous studies have shown EUS-GBD to be a viable option for acute cholecystitis, but data on its application in this specific demographic are scarce. Understanding the outcomes in such patients is crucial for improving treatment protocols and patient safety.
Methods
This was a retrospective analysis of consecutive patients who underwent EUS-GBD using electrocautery-enhanced LAMS at a single center. The study included 10 patients, all of whom were extremely elderly and frail, with a median age of 90 years. The procedures were performed via a transduodenal approach, and the primary outcome was clinical success, while technical success was also assessed.
Results
The primary endpoint of clinical success was achieved in 9 of the 10 patients (90%). Technical success was 100%, with all procedures completed successfully. The median stent deployment time was 3.5 minutes, and the median total procedure time was 16 minutes. One patient died on postoperative day 1 due to complications, which highlights the risks involved.
Interpretation
The findings suggest that EUS-GBD can be technically successful in extremely elderly and frail patients, aligning with previous literature on its efficacy. However, the clinical success rate of 90% must be interpreted with caution due to the small sample size and the significant mortality observed. This raises concerns about the clinical significance of the results and emphasizes the need for careful patient selection in this vulnerable population.
Key findings
- Technical success achieved in 10 patients (100%)
- Clinical success achieved in 9 of 10 patients (90%)
- Median age of patients was 90 years
- Median Clinical Frailty Scale score was 7
- Median stent deployment time was 3.5 min
- Median total procedure time was 16 min
Limitations
- small sample size of n=10
- single-center study limits generalizability
- no long-term follow-up reported
- one postoperative death raises safety concerns