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Minimally Invasive Management of Acute Cholecystitis

 

Acute cholecystitis is a complex gallbladder inflammation often requiring urgent intervention. 

Historically, percutaneous transhepatic gallbladder drainage (PT GBD) has been the standard approach, but it is associated with patient discomfort, external drains, and notable limitations. 

The European Society of Gastrointestinal Endoscopy (ESGE) recommends that, in patients at high surgical risk, EUS-guided GBD should be favoured over PT-GBD where both techniques are available, owing to the lower rates of adverse events and need for re interventions in EUS-GBD.1

At Boston Scientific, we are helping advance care for these patients with the ground breaking Hot AXIOS™ Stent and Electrocautery-Enhanced Delivery System. Across Europe, more than 400 endoscopists are already performing drainage procedures with lumen apposing metal stents (LAMS) and are now able to offer this novel option to nonsurgical patients with acute cholecystitis who would previously have required percutaneous drainage.2

Hot Axios

Hot AXIOS™ for Acute Cholecystitis

As part of our therapeutic Endoscopic Ultrasound (EUS) portfolio, the Hot AXIOS™ Stent and Electrocautery-Enhanced Delivery System combines a cautery enabled access catheter with the therapeutic AXIOS Stent for a simplified workflow. 

It enables efficient, controlled access with the electrocautery enhanced delivery system while minimising radiofrequency interference with visualisation. The system has demonstrated 88-96% clinical success in the treatment of acute cholecystitis.3-12

Learn about the Hot AXIOS™ Stent and Electrocautery-Enhanced Delivery System
 

Video Resources

Preparing the patient for GBD

   

Choosing a site

   

Selecting a stent size*
*FDA Field Action review in progress for Hot AXIOS stents sizes 6mmx8mm, 8mmx8mm, and 20mmx10mm

   

Critical deployment steps

   

Further interventions that may be needed Clinical

   

  

Clinical Evidence

International Guidelines on Acute Cholecystitis Management

These guidelines provide key recommendations for the management of acute cholecystitis highlighting the standard and emerging practices, including laparoscopic cholecystectomy and EUS-GBD tailored to the needs of patients who may not be suitable for traditional surgical interventions.

  • World Society of Emergency Surgery (WSES) Guidelines: The 2020 WSES guidelines emphasise early laparoscopic cholecystectomy as the standard of care for acute cholecystitis. However, they acknowledge the role of gallbladder drainage, including the use of LAMS, in high-risk patients.13
  • European Society of Gastrointestinal Endoscopy: ESGE guidelines endorse endoscopic EUS-GBD using LAMS as an alternative to percutaneous cholecystostomy in high-risk surgical patients.14
  • Tokyo Guidelines: The Tokyo Guidelines also support the use of EUS-GBD with LAMS for high-risk patients who are not suitable candidates for surgery.5
     

Comparative Benefits of Hot AXIOS™ EUS-GBD over PT-GBD

In a randomised multicentre controlled superiority trial, EUS-GBD offered significant advantages over PT-GBD.3

GBD infograph

In multiple studies, EUS-GBD demonstrated significantly fewer adverse events compared to PT-GBD.15-21 In another study, patients undergoing EUS-GBD conversion also experienced lower rates of recurrent acute cholecystitis (p=0.012) and unplanned readmissions due to gallstone-related diseases (p=0.022) compared to those receiving conservative treatment.22
 

Expert Perspectives

Hear how leading endoscopists, surgeons, and interventional radiologists are integrating EUS-GBD into their acute cholecystitis pathways and what it takes to drive real change across the multidisciplinary team.

    

Hear from a surgeon’s perspective on GBD with Hot AXIOS

Watch Dr Hayato Kurihara from Clinical Referral of the Emergency Surgery department of Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico in Milan (Italy), as he shares his insights on gallbladder drainage using Hot AXIOS™ Stent and Electrocautery Enhanced Delivery System.

“Local pathways for these type of patients. These pathways can be a little bit different from hospital to hospital as you have to consider the logistics, the interventional radiologist, and endoscopy availability”

– Dr Hayato Kurihara, MD

“I involve the endoscopist very soon when facing a patient with acute cholecystitis and frailty […] we start with the multi-disciplinary approach for this patient.”
– Dr Hayato Kurihara, MD

How and When to Involve your Endoscopist

Get an expert perspective from Dr Hayato Kurihara on gallbladder drainage with Hot AXIOS™ and how to involve your endoscopist.

“I involve the endoscopist very soon when facing a patient with acute cholecystitis and frailty […] we start with the multi-disciplinary approach for this patient.”
– Dr Hayato Kurihara, MD

Guidelines and Pathways

Get an expert perspective from Dr Hayato Kurihara on gallbladder drainage with Hot AXIOS™ and the different guidelines and pathways for this procedure.

“Local pathways for these type of patients. These pathways can be a little bit different from hospital to hospital as you have to consider the logistics, the interventional radiologist, and endoscopy availability”

– Dr Hayato Kurihara, MD

Expert Resources

Experts across different specialties are now including Hot AXIOS™ in their patient pathways. If you’re considering optimising your acute cholecystitis care, these dedicated resources may help.

Acute Cholecystitis Patients’ Pathways: Meeting In A Box

Explore a comprehensive set of presentations, nurse training materials, and practical pathway tools—alongside a special report with Global Business Media, featuring eight articles on EUS-GBD and its role in advancing acute cholecystitis treatment.

Access Meeting in a Box
Hot axios

Hot AXIOS™ Learning Path

Further your professional development through our tailored Hot AXIOS™ Learning Path, combining digital and face-to-face training to equip physicians with the knowledge and skills needed to perform EUS-guided drainage procedures with confidence.

Explore Hot AXIOS™ Learning Path

   

Explore our Full EUS Portfolio

Our EUS portfolio spans both diagnostic and therapeutic applications, supporting clinicians across tissue acquisition, lesion characterisation, and minimally invasive drainage procedures.

For information on EUS diagnostic applications including tissue acquisition, visit our EUS Diagnostics page

Discover more about the Hot AXIOS™ in the management of chronic pancreatitis

acquire-needle-clinical-settings

   

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Product catalogue​

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AXIOS™ Stents Indications for Use

Electrocautery Enhanced AXIOS™ Stents (6mmx8mm*, 8mmx8mm*, 10mmx10mm, 15mmx10mm and 20mmx10mm*)

Electrocautery Enhanced AXIOSTM Stents (15mmx15mm)

Cold AXIOS™

*FDA Field Action review in progress for Hot AXIOS stents sizes 6mmx8mm, 8mmx8mm, and 20mmx10mm

References

1. Van der Merwe SW, et al. Endoscopy. 2022;54(2):185-205.

2. Data on file. Active accounts tracked through sales data.

3. Teoh AYB, et al. Gut. 2020;69(6):1085-91.

4. Dollhopf M, et al. Gastrointest Endosc. 2017;86(4):636-43.

5.  Lisotti A, et al. Surg Endosc. 2022;36(1):569-78.

6. Chan SM, et al. Gastrointest Endosc. 2017;85(6):1225-32.

7. Teoh AYB, et al. Endoscopy. 2017;49(2):130-8.

8. Teoh AYB, et al. Gastrointest Endosc. 2021;93(3):577-83.

9. Yuste RT, et al. Ann Gastroenterol. 2019;32(5):514-21.

10. Torres Yuste R, et al. Dig Endosc. 2020;32(4):608-15.

11. Anderloni A, et al. Ann Gastroenterol. 2018;31(6):735-41.

12. Irani S, et al. Clin Gastroenterol Hepatol. 2017;15(5):738-45.

13. Sartelli M, et al. World J Emerg Surg. 2020;15(1):1-24.

14. Dumonceau JM, et al. Endoscopy. 2022;54(1):1-15.

15. Boregowda U, et al. Diagnostics. 2023;13(4):657.

16. Cucchetti A, et al. Gastrointest Endosc. 2022;95:399-406.

17. Hemerly MC, et al. Surg Endosc. 2023;37:2421-38.

18. Luk SWY, et al. Endoscopy. 2019;51:722-32.

19. Lyu Y, et al. J Laparoendosc Adv Surg Tech. 2021;31:1232-40.

20. Cho SH, et al. Dig Endosc. 2023;35:658-67.

21. Siddiqui A, et al. Surg Endosc. 2019;33:1260-70.

22. Chon HK, et al. Gut Liver. 2024;18:348-57.

23. Binda C, Anderloni A, Forti E, Fusaroli P, Macchiarelli R, Manno M, et al. EUSGuided Gallbladder Drainage Using a Lumen-Apposing Metal Stent for Acute Cholecystitis: Results of a Nationwide Study with Long-Term Follow-Up. Diagnostics (Basel). 2024;14(4).

24. Trieu JA, Gilman AJ, Hathorn K, Baron TH. Large Single-center Experience with Long-term Outcomes of EUS-guided Transmural Gallbladder Drainage. J Clin Gastroenterol. 2024;58(7):702-7.

25. Binda C, Anderloni A, Fugazza A, Amato A, de Nucci G, Redaelli A, et al. EUSguided gallbladder drainage using a lumen-apposing metal stent as rescue treatment for malignant distal biliary obstruction: a large multicenter experience. Gastrointest Endosc. 2023;98(5):765-73.

CAUTION: The law restricts these devices to sale by or on the order of a physician. Indications, contraindications, warnings, and instructions for use can be found in the product labelling supplied with each device or at www.IFU-BSCI.com. Products shown for INFORMATION purposes only and may not be approved or for sale in certain countries. This material not intended for use in France.