Early laparoscopic cholecystectomy is considered in most cases the treatment of choice for acute cholecystitis. However, in the elderly, in critically ill patients, and in those with significant comorbidities, cholecystectomy is considered a high-risk procedure, and gallbladder drainage (GBD) is recommended as an alternative treatment.¹

Until now, percutaneous transhepatic gallbladder drainage (PTGBD) has been the most common GBD technique used in clinical practice. Even though the technical success rate of PTGBD is high at 98.9%, clinical success is lower at 86.0%, with adverse events such as intrahepatic hemorrhage, pneumothorax, biliary peritonitis, and pneumonia contributing to a procedure mortality rate of 4.0 %.² With readmission rates as high as 42% and reccurance between 4.1-22% additional treatment options are required to complement existing management strategies.³

The Hot AXIOS™ Stent and Electrocautery System is one additional treatment option for patients at high risk or unsuitable for surgery. Hot AXIOS™ is specifically designed and indicated for the drainage of the biliary tract. Published literature has demonstrated clinical and technical success for symptomatic cholecystitis in patients at high risk or unsuitable for surgery by creating a new temporary opening between the gall-bladder and GI tract. EUS-GBD using Hot AXIOS™ is an option in high-risk surgical patients with acute cholecystitis when performed by an experienced endoscopist.^{4 **}