{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T09:48:57Z","timestamp":1782121737280,"version":"3.54.5"},"reference-count":24,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["DEN Open"],"published-print":{"date-parts":[[2027,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Endoscopic ultrasound\u2010guided gallbladder drainage (EUS\u2010GBD) using lumen\u2010apposing metal stents (LAMS) is a treatment option for acute cholecystitis in high\u2010risk surgical patients. However, data on extremely elderly and frail patients are limited. We report our initial experience with EUS\u2010GBD using electrocautery\u2010enhanced LAMS in this population after reimbursement approval in Japan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed consecutive patients who underwent EUS\u2010GBD using electrocautery\u2010enhanced LAMS for acute cholecystitis at a single center after reimbursement approval in June 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Ten patients (median age, 90 years; median Clinical Frailty Scale score, 7) underwent EUS\u2010GBD. All procedures were performed via a transduodenal approach using a 10\u2010mm LAMS. Technical success was achieved in all patients. Clinical success was achieved in nine of the 10 patients (90%); one patient with Grade III cholecystitis complicated by severe pneumonia and heart failure died on postoperative day 1 before clinical assessment. The median stent deployment time was 3.5\u00a0min, and the median total procedure time was 16\u00a0min. Cholecystoscopy through the LAMS using a slim endoscope was feasible when required.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this pilot study, EUS\u2010GBD using electrocautery\u2010enhanced LAMS was technically successful in extremely elderly and frail patients. Although short\u2010term outcomes appeared acceptable in most patients, the single POD1 death underscores the importance of careful patient selection. These preliminary findings require validation in larger studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>N\/A.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/deo2.70369","type":"journal-article","created":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T09:05:40Z","timestamp":1782119140000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Initial Experience With Endoscopic Ultrasound\u2010Guided Gallbladder Drainage Using Lumen\u2010apposing Metal Stents in Extremely Elderly and Frail Patients"],"prefix":"10.1002","volume":"7","author":[{"given":"Kiyoyuki","family":"Kobayashi","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Hepatology HITO Medical Center  Shikokuchuo Japan"},{"name":"Division of Innovative Medicine for Hepatobiliary and 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