Clin Endosc.  2015 Sep;48(5):411-420. 10.5946/ce.2015.48.5.411.

Endoscopic Gallbladder Drainage for Acute Cholecystitis

Affiliations
  • 1Division of Gastroenterology and Hepatology, Weill Cornell Medical College, Cornell University, New York, NY, USA. mkahaleh@gmail.com
  • 2Division of Gastroenterology and Hepatology, Central University Hospital of Asturias, Asturias, Spain.
  • 3Digestive and Liver Diseases, Columbia University Medical Center, New York, NY, USA.

Abstract

BACKGROUND/AIMS
Surgery is the mainstay of treatment for cholecystitis. However, gallbladder stenting (GBS) has shown promise in debilitated or high-risk patients. Endoscopic transpapillary GBS and endoscopic ultrasound-guided GBS (EUS-GBS) have been proposed as safe and effective modalities for gallbladder drainage.
METHODS
Data from patients with cholecystitis were prospectively collected from August 2004 to May 2013 from two United States academic university hospitals and analyzed retrospectively. The following treatment algorithm was adopted. Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and cystic duct stenting was initially attempted. If deemed feasible by the endoscopist, EUS-GBS was then pursued.
RESULTS
During the study period, 139 patients underwent endoscopic gallbladder drainage. Among these, drainage was performed in 94 and 45 cases for benign and malignant indications, respectively. Successful endoscopic gallbladder drainage was defined as decompression of the gallbladder without incidence of cholecystitis, and was achieved with ERCP and cystic duct stenting in 117 of 128 cases (91%). Successful endoscopic gallbladder drainage was also achieved with EUS-guided gallbladder drainage using transmural stent placement in 11 of 11 cases (100%). Complications occurred in 11 cases (8%).
CONCLUSIONS
Endoscopic gallbladder drainage techniques are safe and efficacious methods for gallbladder decompression in non-surgical patients with comorbidities.

Keyword

Transgastric; Endoscopic ultrasound-guided gallbladder drainage; Cholecystitis; Metal stent; Fully covered self-expanding metal stent

MeSH Terms

Cholangiopancreatography, Endoscopic Retrograde
Cholecystitis
Cholecystitis, Acute*
Comorbidity
Cystic Duct
Decompression
Drainage*
Gallbladder*
Hospitals, University
Humans
Incidence
Prospective Studies
Retrospective Studies
Stents
United States
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