Long-term lumen-apposing metal stents in endoscopic ultrasound-guided gallbladder drainage: Late adverse events and stent removal

Table 2 Representative studies and pooled analyses of endoscopic ultrasound-guided gallbladder drainage with lumen-apposing metal stents

Ref.	Design and patients	Technical success	Clinical success	Follow-up	Key long-term findings
Teoh et al[27], 2020	Randomized trial vs PTGBD; 80 patients recruited (39 EUS-GBD, 41 PTGBD); 39 vs 40 analyzed	97.4%	92.3%	1 year	1-year adverse event rates were 10/39 (25.6%) vs 31/40 (77.5%)b for PTGBD; recurrent cholecystitis 1/39 (2.6%) vs 8/40 (20%); reintervention beyond 30 days 1/39 (2.6%) vs 12/40 (30%)
Binda et al[21], 2024	Multicenter cohort; 116 patients; mean age 82.7 years	94%	87.1%	Mean 309 days	Adverse events in 12/116 (10.3%); 8 intraprocedural, 1 early, 3 late; no fatal adverse events; no recurrence among 40 patients followed beyond 1 year
Dollhopf et al[35], 2017	Multicenter cohort; 75 patients; electrocautery-enhanced LAMS	98.7%	95.9%	Not reported as a single value	Overall adverse events 8/75 (10.7%); late events in 6 patients: Recurrent cholecystitis (3), migration (2), Bouveret syndrome (1); all managed without surgery
David et al[36], 2025	Multicenter cohort; 109 patients; 18 United States centers	99.1% (108/109)	Initial 97.2% (106/109); long-term 89.9% (98/109)	Median 140 days (IQR 76-330; range 30-1188)	Events beyond 30 days in 10/109 (9.2%), of which 7/109 (6.4%) were LAMS-specific; LAMSs removed in 24/109 (22%); recurrent cholecystitis 1/24 (4.2%) after removal vs 7/85 (8.2%) after retention, with no statistically significant difference; the decline from initial to long-term clinical success and the short median follow-up limit long-term inferences
Yuste et al[43], 2019	Single-center series; 22 of 47 patients with dwell time > 1 year	NR1	NR1	Median 24.4 months (IQR 18.2-42.4)	No stent-related events beyond 12 months; 1 patient (4.5%) readmitted for gallstone-related disease; one completely buried stent at 61.5 months with patent fistula
Martinez-Moreno et al[44], 2023	Single-center registry; 50 patients analyzed; 3-year design	91.2% (62/68)2	98% (49/50)	Median 25.0 months	Adverse events in 18%, 20%, and 26% of patients during years 1-3; 14 LAMS-related events in 11 patients (22%) at a median of 674 days; only 5/14 (35.7%) symptomatic, and late events increasingly asymptomatic; all 7 migrations (14%) asymptomatic; symptomatic events accounted for 66.7% of events associated with a transgastric stent vs 12.5% of those from a transduodenal stenta; recurrent cholecystitis 2/50 (4%); no stent-related bleeding or stent-related death
Fabbri et al[34], 2022	Proportion meta-analysis; 27 studies; 1004 patients	98.0% (95%CI: 96.3-99.3)	95.4% (95%CI: 92.8-97.5)	Varied across studies	Pooled procedure-related adverse event rate was 14.8%; meta-regression identified institutional volume and stent type as outcome modifiers
Canakis et al[45], 2026	Meta-analysis restricted to follow-up ≥ 1 year; 18 studies; 701 patients	95.8% (95%CI: 93.9-97.2)	94.3% (95%CI: 92-96)	≥ 1 year by design	Recurrent cholecystitis rate at or beyond 1 year was 4.2%; 1-year readmission rate was 19%; reintervention rate 6%; repeat endoscopy due to occlusion 2.9%; mean patency 418.8 days (I2 = 98%); approximately half the patients did not receive a LAMS

^aP < 0.05, transgastric vs transduodenal stent position.

^bP < 0.01, endoscopic ultrasound-guided gallbladder drainage vs percutaneous transhepatic gallbladder drainage.

¹The series was restricted to the 22 of 47 patients whose stent remained in situ for more than 12 months; procedural success was therefore not an endpoint and is not reported.

²Denominator is the 68 patients assessed for gallbladder drainage; of the 62 technically successful procedures, 12 were performed for indications other than acute cholecystitis and were excluded, leaving 50 patients for analysis.

EUS-GBD: Endoscopic ultrasound-guided gallbladder drainage; IQR: Interquartile range; LAMS: Lumen-apposing metal stent; NR: Not reported; PTGBD: Percutaneous transhepatic gallbladder drainage.