Treatment of gallstone disease involves cholecystectomy for cholelithiasis and ERCP for choledocholithiasis.However,cholecystectomy may be risky elderly patients and those with significant comorbidities.In surgically altered patients, ERCP can not be possible for choledocholithiasis,and in patients with preserved gastrointestinal anatomy,ERCP may also fail.The long-term outcomes of EUS-guided treatment performed between 2011 and 2022 in a group of such patients were evaluated.

The study included 23 patients.In the bile duct group, 16 patients consisted of 13 males and 3 females.In the gallbladder group,6 were female and 1 was male.The mean age was 62 ± 18.6 (range: 28–86) in the bile duct group and 73 ± 11.7(51–83) in the gallbladder group.In the bile duct group,one patient had a hepaticojejunostomy without tract surgery,12 had gastroenterostomy (including one with Billroth II and nine with Roux-en-Y anastomosis), and one had a total gastrectomy with esophagojejunostomy.In two patients, the anatomy was physiological,but ERCP had failed.All patients in the gallbladder group had recurrent cholecystitis and had high surgical risk. Under EUS guidance,13 patients underwent hepaticogastrostomy,one underwent hepatoesophagostomy,two underwent choledochoduodenostomy,five underwent cholecystogastrostomy, and two underwent cholecystoduodenostomy.In the bile duct patients with normal anatomy,choledochoduodenostomy was preferred. After fistula formation,the stones were mostly treated with antegrade laser lithotripsy under cholangioscopic guidance.

Technical success was achieved in all patients.However,seven of those with bile duct stones continued to experience episodes of cholangitis.In all of these patients,the diameter of the common bile duct or main hepatic duct was greater than 20 mm.In the other six patients, the duct diameter was 15 mm or less,and no further episodes of cholangitis occurred.In patients who underwent the procedure for gallbladder stones,clinical success was 100%.

EUS-guided treatment is a safe and highly effective option for managing bile duct stones in which ERCP is not feasible and gallbladder stones in patients at high risk for cholecystectomy.