EUS-guided cholecystenterostomy: a new technique (with videos).
BACKGROUND
The cornerstone of management for acute cholecystitis is cholecystectomy. However, surgical intervention is contraindicated in the occasional patient. EUS-guided transduodenal gallbladder drainage may represent an effective minimally invasive alternative.


OBJECTIVE
To describe a new technique, EUS-guided cholecystenterostomy.


METHODS
A single-center retrospective case series.


METHODS
Three patients with severe acute cholecystitis unresponsive to conservative management who were deemed unfit for cholecystectomy.


METHODS
Under combined EUS and fluoroscopic guidance, cholecystenterostomy was performed via needle puncture, guidewire insertion, cystoenterostome passage, and stent placement.


METHODS
Technical success, clinical progress, immediate and long-term complications, and recurrence of cholecystitis.


CONCLUSIONS
Pilot series.


RESULTS
Cholecystenterostomy was performed successfully in all patients. Rapid improvement in clinical status and inflammatory parameters ensued. A minor intraprocedural bile leak occurred in 1 patient, without significant clinical sequelae. Cholecystitis did not recur in any patient.


CONCLUSIONS
EUS-guided cholecystenteric drainage is technically feasible and appears to be a safe and effective procedure. Via this technique, gallbladder drainage and resolution of related sepsis may be achieved in patients with acute cholecystitis who are unfit for surgery.
Kwan
Vu
V
Department of Gastroenterology and Hepatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
Eisendrath
Pierre
P
Antaki
Fadi
F
Le Moine
Olivier
O
Devière
Jacques
J
D000208:Acute Disease; D000328:Adult; D000368:Aged; D002408:Catheters, Indwelling; D002763:Cholecystectomy; D002764:Cholecystitis / Q000601:surgery*; D000075202:Contraindications; D004322:Drainage / Q000379:methods; D019160:Endosonography / Q000379:methods*; D004766:Enterostomy / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D010865:Pilot Projects; D015607:Stents; D018084:Ultrasonography, Interventional / Q000379:methods*