Decompensated Liver Cirrhosis Treated with EUS-Guided Cholecystogastrostomy

A 60-year-old male visited the emergency department of Max Super Speciality Hospital, Saket, with complaints of severe pain in the abdomen for the past three days and fever for the past 24 hours. At presentation, he was hypotensive, responsive to fluid resuscitation, and a suspected case of sepsis with septic shock. The ultrasound of the abdomen revealed a gallbladder calculi that impacted the gallbladder’s neck with thick walls. Incidentally, the liver was also found to be shrunken with ascites. The diagnosis was Decompensated Liver Cirrhosis with Acute Cholecystitis and Sepsis & Septic Shock. 

The patient was shifted to the ICU and started on conservative management & intravenous antibiotics. Given the patient's poor general condition and Decompensated Liver Cirrhosis, surgery was considered risky and deferred after consultation with the surgeons. Under Endoscopic Ultrasound  (EUS) guidance, a transgastric puncture of the gallbladder was done, and a metal stent was placed between the gallbladder and stomach. The pus in the gallbladder was thus drained internally into the stomach (Cholecystogastrostomy). With gallbladder drainage, the patient's condition improved rapidly, and he was discharged after five days. 


EUS-guided Cholecystogastrostomy is a novel endoscopic technique of gallbladder drainage useful in patients deemed unsuitable for surgery.