Elective symptomatic gallbladder stone treatment by EUS (with video).

EUS gallbladder (GB) drainage technique started in 2007 when the double-pigtail plastic stents or nasocystic drainage tube was used for the drainage. Subsequently, therapeutic EUS has evolved, especially with the introduction of the electrocautery-enhanced lumen-apposing metal stent (EC-LAMS) for the treatment of GB stones.[1,2] An 83-year-old woman with Alzheimer’s disease and hypertension was addressed to our evaluation because of symptomatic GB stones. A computed tomography scan revealed the presence of multiple stones <1 cm into the GB in the absence of dilation and stones into the common bile duct. The case was discussed during our multidisciplinary meeting, and an EUS plus EC-LAMS with 2-month removal was proposed. We performed a freehand cholecystogastrostomy (CGS) under EUS guidance from the anterior wall of the gastric antrum with a 10 mm × 20 mm Hot-Spaxus™ (Taewoong Medical Co., Gimpo, Korea)[3-5] [Figure 1]. After EC-LAMS placement, no balloon dilation was performed and no double-pigtail plastic stent was placed. The stent was placed with the aim to obtain a spontaneous stone migration into the gastric cavity [Video 1]. At 1 month, the patient underwent esophagogastroduodenoscopy showing the correct placement of the stent with only one stone inside. At 2 months, with a pediatric gastroscope, we explored the GB that was empty from stones and the stent was easily removed by a standard gastroscope and tooth-rat forceps. No plastic pigtail stents were placed across the CGS. The patient was followed for 6 months after stent removal, and no early and late adverse events were experienced. In our opinion, probably, in future, the elective GB treatment of symptomatic stones should be a valid alternative in the elderly or unfit for surgery patients [Video 1].Figure 1: Proximal flange of the 10 mm × 20 mm EC-LAMS opened inside the stomach. EC-LAMS: Electrocautery-enhanced lumen-apposing metal stentDeclaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.