Bedside endoscopic ultrasound guided gallbladder drainage in the Intensive Care Unit in critically ill patients

Cholecystectomy is the preferred treatment for acute cholecystitis in average surgical-risk patients. For those with high perioperative risk, percutaneous transhepatic gallbladder drainage (PT-GBD) and endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) are alternatives. However, PT-GBD is limited by contraindications such as large hepatic masses, significant ascites, and coagulopathy, and some critically ill patients cannot be transferred for PT-GBD or EUS-GBD. This case series demonstrates that bedside EUS-GBD in the ICU is technically feasible and safe for critically ill patients who are unsuitable for other interventions. Three cases involving severely ill patients successfully underwent bedside EUS-GBD with initial post-procedure improvement. Unfortunately, all patients eventually required comfort care due to their severe underlying conditions. These cases highlight EUS-GBD as an effective bedside option for gallbladder drainage in ICU patients when supported by multidisciplinary teams. Further research could confirm its expanded role in managing high-risk patients in intensive care.