Abstract / Summary
Abstract Purpose This study aimed to evaluate the contemporary procedural adaptation and clinical outcomes of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using electrocautery-enhanced lumen-apposing metal stents (EC-LAMS) in a multicenter cohort. Methods We retrospectively analyzed the data from consecutive patients with acute cholecystitis who underwent primary EUS-GBD with EC-LAMS at three tertiary referral centers between October 2024 and January 2026. Procedural adaptation was assessed using cumulative sum (CUSUM) analysis of EUS-GBD time, total procedural time, and early and late adverse events (AEs). Multivariate regression analyses were performed to evaluate the association between the cumulative procedural experience and procedural outcomes. Results A total of 111 patients underwent EUS-GBD performed by the three operators. The technical and clinical success rates were 100% and 97.3%, respectively. Early and late AEs occurred in 3.6% and 4.5% of the patients, respectively. Procedure-time CUSUM analyses showed peak points after 6, 7, and 10 procedures for the three operators, suggesting early improvement in procedural efficiency. By contrast, no operator crossed the prespecified AE-based CUSUM decision interval (h = 2.71). In regression analyses, EUS-GBD time decreased by 0.58 min for every 10 additional procedures performed (95% confidence interval [CI], − 0.81 to − 0.35; P < 0.001) and by 1.01 min in total procedural time (95% CI, − 1.54 to − 0.48; P < 0.001). Conclusions Contemporary EUS-GBD using EC-LAMS achieved favorable clinical outcomes with progressive improvement in procedural efficiency, supporting rapid procedural adaptation to this standardized technique.