Clinical Outcomes of Primary versus Conversion Endoscopic Ultrasound-Guided Gallbladder Drainage after Percutaneous Drainage: A Multicenter Study

초록

OBJECTIVE: Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is recommended over percutaneous transhepatic gallbladder drainage (PTGBD) in patients with acute cholecystitis who are at high surgical risk. However, PTGBD remains necessary in certain scenarios and evidence regarding conversion to EUS-GBD remains limited. This study aimed to compare primary and conversion EUS-GBD. METHODS: We retrospectively analyzed patients with acute cholecystitis who underwent EUS-GBD using electrocautery-enhanced lumen-apposing metal stents (EC-LAMS) at three tertiary centers. Outcomes were compared between primary and conversion EUS-GBD after PTGBD. The primary outcome was technical success. The secondary outcomes were clinical success, procedure time, adverse events, and stent patency. Inverse probability of treatment weighting (IPTW) was used for adjustment based on baseline characteristics, including age, comorbidity, and malignancy. RESULTS: A total of 141 patients were included (primary EUS-GBD, n = 117; conversion EUS-GBD, n = 24). The conversion EUS-GBD group had more malignant diseases and higher Charlson Comorbidity Index scores. In the conversion group, gallbladder distension was achieved via the existing PTGBD catheter using contrast medium and saline. Technical success was similar between primary and conversion EUS-GBD (98.3% vs. 95.8%, P = 0.431) and remained comparable after IPTW adjustment. The clinical success, adverse events, and stent patency rates were also similar. Although the procedure time was longer in the conversion EUS-GBD group, it became comparable after IPTW adjustment. CONCLUSIONS: Conversion EUS-GBD is comparable to primary EUS-GBD in terms of technical success and safety. Conversion EUS-GBD may be a feasible option when the primary approach is not suitable. Copyright © 2026 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

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