Clin Endosc.  2019 May;52(3):262-268. 10.5946/ce.2018.183.

Endoscopic Ultrasonography-Guided Gallbladder Drainage as a Treatment Option for Acute Cholecystitis after Metal Stent Placement in Malignant Biliary Strictures

• Kozakai F
• Kanno Y
• Ito K
• Koshita S
• Ogawa T
• Kusunose H
• Masu K
• Sakai T
• Murabayashi T
• Yonamine K
• Kawakami Y
• Fujii Y
• Miyamoto K
• Noda Y

• KMID: 2449767
• DOI: http://doi.org/10.5946/ce.2018.183

Abstract

BACKGROUND/AIMS
It is often difficult to manage acute cholecystitis after metal stent (MS) placement in unresectable malignant biliary strictures. The aim of this study was to evaluate the feasibility of endoscopic ultrasonography-guided gallbladder drainage (EUS-GBD) for acute cholecystitis.
METHODS
The clinical outcomes of 10 patients who underwent EUS-GBD for acute cholecystitis after MS placement between January 2011 and August 2018 were retrospectively evaluated. The procedural outcomes of percutaneous transhepatic gallbladder drainage (PTGBD) with tube placement (n=11 cases) and aspiration (PTGBA) (n=27 cases) during the study period were evaluated as a reference.
RESULTS
The technical success and clinical effectiveness rates of EUS-GBD were 90% (9/10) and 89% (8/9), respectively. Severe bile leakage that required surgical treatment occurred in one case. Acute cholecystitis recurred after stent dislocation in 38% (3/8) of the cases. Both PTGBD and PTGBA were technically successful in all cases without severe adverse events and clinically effective in 91% and 63% of the cases, respectively.
CONCLUSIONS
EUS-GBD after MS placement was a feasible option for treating acute cholecystitis. However, it was a rescue technique following the established percutaneous intervention in the current setting because of the immature technical methodology, including dedicated devices, which need further development.

Keyword

Unresectable malignant biliary stricture; Acute cholecystitis; Endscopic ultrasonography-guided gallbladder drainage; Percutaneous transhepatic gallbladder drainage; Percutaneous transhepatic gallbladder aspiration

MeSH Terms

Bile
Cholecystitis, Acute*
Constriction, Pathologic*
Dislocations
Drainage*
Gallbladder*
Humans
Retrospective Studies
Stents*
Treatment Outcome

Figure

• 

  Fig. 1. Kaplan-Meier curve of the cumulative rate of cases without recurrence of acute cholecystitis after endoscopic ultrasonography-guided gallbladder drainage. The mean time to recurrence was 252 days (95% confidence interval, 63–375 days).

• 

  Fig. 2. Overall survival period after the effective intervention for acute cholecystitis. The median survival period was 270 days (95% confidence interval [CI], 72–362 days) after endoscopic ultrasonography-guided gallbladder drainage (EUS-GBD), 178 days (95% CI, 97–259 days) after percutaneous transhepatic gallbladder drainage (PTGBD), and 188 days (95% CI, 107–269 days) after percutaneous transhepatic gallbladder aspiration (PTGBA).

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