title: EUS-guided cholecystenterostomy: a new technique (with videos).
abstract: 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.
authors.affiliation: Department of Gastroenterology and Hepatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Vu
authors.initials: V
authors.lastname: Kwan
authors.forename: Pierre
authors.initials: P
authors.lastname: Eisendrath
authors.forename: Fadi
authors.initials: F
authors.lastname: Antaki
authors.forename: Olivier
authors.initials: O
authors.lastname: Le Moine
authors.forename: Jacques
authors.initials: J
authors.lastname: Devière
mesh_terms: 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*