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

Endoscopic Gallbladder Drainage for Acute Cholecystitis

• Widmer J
• Alvarez P
• Sharaiha R
• Gossain S
• Kedia P
• Sarkaria S
• Sethi A
• Turner BG
• Millman J
• Lieberman
• Nandakumar G
• Umrania H
• Gaidhane M
• Kahaleh M

• KMID: 2148553
• DOI: http://doi.org/10.5946/ce.2015.48.5.411

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

Figure

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  Fig. 1 Occlusion cholangiogram during endoscopic retrograde cholangiopancreatography with a balloon catheter showing the tortuous cystic duct and partially filled gallbladder with a large 2.5 cm stone.

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  Fig. 2 Fluoroscopic image of passage of a 0.035-inch hydrophilic Terumo guidewire (Terumo Medical Corp.) from the transpapillary position, through the cystic duct into the gallbladder using a SwingTip endoscopic retrograde cholangiopancreatography cannula (Olympus).

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  Fig. 3 Dilation of the cystic duct tract into the gallbladder using a 6 to 8 Fr Soehendra dilating catheter (Cook Endoscopy).

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  Fig. 4 Deployment of a 7 Fr×15 cm double pigtail plastic stent (Boston Scientific) into the gallbladder from the transpapillary position.

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  Fig. 5 Endoscopic view of a 7 Fr×15 cm double pigtail plastic stent (Boston Scientific) exiting the ampulla with drainage of pus.

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  Fig. 6 Endosonographic view of the gallbladder with a thickened wall measuring 4.5 mm.

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  Fig. 7 Endosonographic view of a gallbladder that has been punctured with a 19 G endoscopic ultrasound-guided aspiration needle (Cook Endoscopy).

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  Fig. 8 Fluoroscopic view of a 19 G endoscopic ultrasound-guided aspiration needle (Cook Endoscopy) that was used to puncture the gallbladder from the duodenal bulb using a linear echoendoscope (GF-UC140P-AL5; Olympus).

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  Fig. 9 Passage of a 0.035-inch Hydra Jagwire (Boston Scientific) into the gallbladder though the 19 G needle (Cook Endoscopy) from the transduodenal position.

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  Fig. 10 Deployment of a 10 mm×80 cm fully covered metal stent (GORE VIABIL; Gore Medical) into the gallbladder from the transduodenal position.

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  Fig. 11 Deployment of 7 Fr×15 cm double pigtail plastic biliary stent (Boston Scientific) through the metal stent into the gallbladder.

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  Fig. 12 Endoscopic view of the deployment of a 7 Fr×15 cm double pigtail plastic biliary stent (Boston Scientific) through the metal stent into the gallbladder. Small pigment stones can be observed in the metal stent.

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  Fig. 13 Endoscopic Gallbladder Drainage Algorithm. ETGD, endoscopic transpapillary gallbladder drainage; EUS-GBD, endoscopic ultrasound-guided gallbladder drainage; PTGBD, percutaneous transhepatic gallbladder drainage.

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