Interventional procedure overview of endoscopic ultrasound-guided gallbladder drainage for acute cholecystitis when surgery is not an option

What the procedure involves

Endoscopic ultrasound-guided gallbladder drainage for acute cholecystitis is typically done under sedation or general anaesthesia using a specialist endoscope with an ultrasound probe and fluoroscopic guidance. Imaging is used before the procedure to determine its feasibility. An anastomotic tract is created into the gallbladder through either the wall of the antrum of the stomach (cholecystogastrostomy) or the wall of the duodenum (cholecystoduodenostomy) and a stent is inserted to establish biliary drainage into the gut and relieve the gallbladder obstruction. Occasionally, the anastomotic tract may be created between the gallbladder and jejunum (cholecystojejunostomy) if the anatomy has been altered by previous surgery.

Different technologies are used to create the anastomotic tract and deploy the stent, and stents can be made of different materials. Single-step devices allow for single-step delivery of the stent without the need to change instruments for track dilation. Multistep devices need track dilation with a cystotome and a biliary balloon.

The aim is to drain bile from the gallbladder and avoid the need for emergency cholecystectomy, particularly in people for whom surgery poses a high risk.