Endoscopic transpapillary gallbladder drainage in patients with acute cholecystitis in whom percutaneous transhepatic approach is contraindicated or anatomically impossible (with video).
BACKGROUND
In patients with acute cholecystitis and at high risk for surgery, decompression of the gallbladder by percutaneous transhepatic gallbladder drainage (PTGBD) or aspiration (PTGBA) is needed as salvage therapy. However, we sometimes encounter patients in whom puncture cannot be performed for several reasons. Recently, endoscopic transpapillary gallbladder drainage (ETGD) has been reported to be safe and effective for acute cholecystitis.


OBJECTIVE
Our purpose was to evaluate the clinical efficacy and safety of ETGD for acute cholecystitis in which a percutaneous transhepatic approach is contraindicated or anatomically impossible.


METHODS
Retrospective case study.


METHODS
This procedure was performed in Tokyo Medical University Hospital.


METHODS
Forty-three patients with acute cholecystitis, including 32 patients taking anticoagulation or antiplatelet drugs, 4 cases of Chilaiditi syndrome, 2 each of acute leukemia, marked ascites, and anatomic abnormality, and 1 case of hemophilia A.


METHODS
All patients underwent ETGD. A 5F nasobiliary-drainage catheter was placed into the gallbladder. In case of failed ETGD, PTGBD or PTGBA was performed subsequently.


METHODS
Efficacy and safety of this technique.


RESULTS
ETGD was achieved in 36 patients (84%) without any serious procedure-related complications. A clinically favorable response for ETGD was seen in 35 patients (97%). In 7 patients in whom ETGD was unsuccessful and 1 patient in which it was ineffective, a percutaneous transhepatic approach was performed with severe hemorrhage biloma in the former and uncontrolled hemorrhage cholecystitis, leading to death in the latter.


CONCLUSIONS
Difficulty of maneuvering the guidewire and drainage tube into the gallbladder.


CONCLUSIONS
Although comparative studies are needed to define the appropriate role of ETGD and percutaneous transhepatic approach, ETGD can be useful in patients with acute cholecystitis in which a percutaneous transhepatic approach is contraindicated or anatomically impossible.
Current affiliations: Department Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
Takao
T
Itoi
Atsushi
A
Sofuni
Fumihide
F
Itokawa
Takayoshi
T
Tsuchiya
Toshio
T
Kurihara
Kentaro
K
Ishii
Shujiro
S
Tsuji
Nobuhito
N
Ikeuchi
Sakiko
S
Tsukamoto
Mani
M
Takeuchi
Takashi
T
Kawai
Fuminori
F
Moriyasu
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000295:instrumentation / Q000379:methods*; D002764:Cholecystitis / Q000000981:diagnostic imaging* / Q000628:therapy*; D015331:Cohort Studies; D004322:Drainage / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014741:Video Recording