Clin Endosc.  2017 May;50(3):301-304. 10.5946/ce.2016.120.

Conversion of Percutaneous Cholecystostomy to Endoscopic Gallbladder Stenting by Using the Rendezvous Technique

• Nam K
• Choi JH

• KMID: 2388829
• DOI: http://doi.org/10.5946/ce.2016.120

Abstract

We report the successful conversion of percutaneous cholecystostomy (PC) to endoscopic transpapillary gallbladder stenting (ETGS) with insertion of an antegrade guidewire into the duodenum. An 84-year-old man presented with severe acute cholecystitis and septic shock. He had significant comorbidities, and emergent PC was successfully performed. Subsequent ETGS was attempted but unsuccessful owing to difficulties with cystic duct cannulation. However, via the PC tract, the guidewire was passed antegradely into the duodenum, and ETGS with a double-pigtail plastic stent was successfully performed with the rendezvous technique. The PC tube was removed, and no recurrence was reported during the 17-month follow-up period. Conversion of PC to ETGS is a viable option in patients with acute cholecystitis who are not candidates for surgery. Antegrade guidewire insertion via the PC tract may increase the success rate of conversion and decrease the risk of procedure-related complications.

Keyword

Cholecystitis, acute; Cholecystostomy; Drainage; Cholangiopancreatography, endoscopic retrograde

MeSH Terms

Aged, 80 and over
Catheterization
Cholangiopancreatography, Endoscopic Retrograde
Cholecystitis, Acute
Cholecystostomy*
Comorbidity
Cystic Duct
Drainage
Duodenum
Follow-Up Studies
Gallbladder*
Humans
Plastics
Recurrence
Shock, Septic
Stents*
Plastics

Figure

• 

  Fig. 1. Fluoroscopic image showing a stricture in the cystic duct (arrows).

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  Fig. 2. Fluoroscopic image showing a percutaneous transgallbladder guidewire being advanced antegradely through the gallbladder and common bile duct into the duodenum.

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  Fig. 3. Fluoroscopic image of coiling of the guidewire within the lumen of the gallbladder.

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  Fig. 4. Fluoroscopic image after positioning of the transpapillary gallbladder stent.

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