Endoscopic Ultrasound-Guided Gallbladder Drainage for Acute Cholecystitis and for Expanded Indications: Technique and Outcomes

Interventional endoscopic ultrasound (EUS) is constantly evolving, thanks to its efficacy for the treatment of several clinical conditions, leading to an extension of applications and indications over the years. Among these, endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has become the preferred treatment for acute cholecystitis (AC) in high surgical risk patients, thanks to the introduction of electrocautery-enhanced lumen-apposing metal stents, which allowed a higher standardization of the technique, although still improving. Despite the significant progress made over the past 10 years, there are still a number of debated issues, above all due to application of this technique in a wider variety of broadened indications, beyond AC. Indeed, increasing evidences are emerging on EUS-GBD as treatment in case of distant malignant biliary obstruction in both primary and rescue scenarios. Additionally, there is preliminary evidence on AC prevention following the implantation of fully-covered self-expandable metal stents during endoscopic retrograde cholangiopancreatography in the malignant setting and on the treatment of gallstone-related diseases in not surgically fit patients. With an emphasis on technical considerations and outcomes, this review attempts to update the current indications for EUS-GBD and provide an overview of potential new fields of application for this technique.