Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using lumen-apposing metal stents (LAMS) provides excellent technical and short-term clinical success. However, being a relatively recent technique, limited evidence is available regarding its long-term performance. The aim of this study was to evaluate long-term clinical outcomes and adverse events (AEs) following EUS-GBD with LAMS.

All EUS-GBD procedures performed in our Digestive Endoscopy Unit between January 2022 and November 2025 were retrospectively reviewed. Patients who underwent LAMS placement and had at least 30 days of follow-up were included. Technical outcomes, long-term clinical outcomes (>30 days), and long-term AEs (>30 days) were collected and analysed.

A total of 99 patients were included (44.9% male; median age 84 years, range 64–97). 

EUS-GBD was performed for acute cholecystitis (AC) in non-surgical candidates in 90.9% of cases and for failed ERCP in 9%. LAMS was deployed from the stomach in 38.4% of patients and from duodenal bulb in 61.6%. Technical success was achieved in 96/99 procedures (97%), and initial clinical success in 95/99 (96%).

Median follow-up was 922 days (range 30-1416). Long term clinical success was observed in 90.9% of patients. AEs occurred in 9 of 99 patients (9%); only one AE occurred within 30 days, while 88.8% occurred during long-term follow-up. 

Late LAMS migration was reported in 3 patients (33.3% of long-term AEs). In all 3 cases the LAMS migrated in the gastrointestinal lumen and patients remained asymptomatic. Migration was incidentally detected during surveillance ultrasound and confirmed by CT imaging. The median time to migration was 474 days (range 358–523) fromEUS-GBD.

Recurrent AC occurred in 6 patients (66.7% of long-term AEs). AC was caused by LAMS occlusion by food impaction in 5/6 cases and in all cases LAMS was deployed form the stomach. All LAMS occlusions were successfully treated endoscopically and the median hospitalisation for recurrent AC was 5 days.

Multivariate analysis showed no association between long-term outcomes and patient age, LAMS size or type, or EUS-GBD indication (AC vs. ERCP failure). However, transgastric LAMS placement was significantly associated with long-term AEs (p < 0.005).

LAMS removal was performed in 12 patients (12.1%). There was no statistical difference in long term AEs between patients with or without stent removal.

During follow-up, overall mortality was 47.5%, with no deaths attributable to EUS-GBD or related AEs. Median time to death was 347 days post-procedure.

EUS-GBD with LAMS is a safe and effective procedure not only in the short term but also over extended follow-up. Long-term clinical efficacy remained high, and the incidence of late AEs was low, supporting the durability and safety of this intervention for patients unfit for surgery.