The Effect of Lumen-Apposing Metal Stent (LAMS) in Acute Cholecystitis Unfit for Surgery: Good Tidings

TL;DR

A minimally invasive endoscopic technique using LAMSs effectively treats acute cholecystitis in patients who cannot undergo surgery.

Contribution

This umbrella review consolidates evidence on the efficacy and safety of EUS-guided gallbladder drainage with LAMSs in high-risk patients.

Findings

EUS-guided gallbladder drainage with LAMSs achieves high technical and clinical success rates.

The procedure is associated with low adverse event rates and effective symptom relief.

The approach reduces the need for surgery in high-risk patients.

Abstract

Acute cholecystitis in patients unfit for surgery presents a significant therapeutic challenge, often requiring alternatives to traditional cholecystectomy. In recent years, endoscopic ultrasound (EUS)-guided gallbladder drainage using Lumen-Apposing Metal Stents (LAMSs) has emerged as a promising minimally invasive approach. This umbrella review synthesizes evidence from existing systematic reviews and meta-analyses evaluating the efficacy and safety of EUS-guided gallbladder drainage with LAMSs in high-surgical-risk patients. The pooled data demonstrate that this approach provides effective symptomatic relief, with high technical and clinical success rates and a low incidence of adverse events. The use of EUS allows real-time visualization and precise access to the gallbladder, contributing to the safety and efficacy of the procedure. These results reinforce the expanding role of endoscopic techniques in managing complex biliary conditions, suggesting that the use of diagnostic EUS in combination with LAMS placement can lead to a significant reduction in the need for surgical intervention among frail patients.

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