Practice Patterns of Endoscopists Performing Endoscopic Gallbladder Drainage

Background and Aims: The standard of care for treatment of patients with acute cholecystitis is cholecystectomy. However, many patients are unfit for surgery due to substantial medical comorbidities, or surgery is technically challenging due to anatomic considerations. Options for patients who are not surgical candidates include percutaneous cholecystostomy tube placement by interventional radiology, endoscopic gallbladder drainage (EGBD), or conservative management. Over the last decade, techniques of EGBD have been employed for temporary or definitive gallbladder drainage in patients with acute cholecystitis who are not surgical candidates. Despite growing interest and clinical use of EGBD, little is known about practice patterns of EGBD. Our aim was to survey endoscopists to evaluate the practice patterns and technical considerations regarding EGBD. Methods: An 18-item survey was distributed to all members of the American Society of Gastrointestinal Endoscopy. Each response was included in the final analysis. Descriptive statistics were calculated using frequencies and percentages. Results: Responses were received from 217 endoscopists. Of these, 178 perform endoscopic ultrasound-guided gallbladder draining and 178 perform endoscopic transpapillary gallbladder drainage. The preferred approach for EGBD was endoscopic ultrasound-guided gallbladder drainage in 58.8%, endoscopic retrograde cholangiopancreatography (ERCP)-guided transpapillary gallbladder stent placement in 30.2%, and no preference in 11%. Conclusion: Despite growing interest in EGBD, significant heterogeneity in practice patterns exists. Further study is needed to better understand these differences and provide data for future guidelines.