Predicting the success of endoscopic transpapillary gallbladder drainage for patients with acute cholecystitis during pretreatment evaluation.
BACKGROUND
Although endoscopic transpapillary gallbladder drainage (ETGBD) has been reported to be an effective treatment for acute cholecystitis, technical difficulties have precluded more widespread use of this technique. Case evaluations that can predict the occurrence of such difficulties should increase the acceptance of ETGBD for acute cholecystitis treatment.


OBJECTIVE
To establish a pretreatment evaluation protocol for patients with acute cholecystitis.


METHODS
Eleven patients with acute cholecystitis who received ETGBD in 2003 or 2004 were enrolled in the present retrospective study. The frequency of success, complications and overall effectiveness of ETGBD for treatment of cholecystitis were measured. Factors that could affect ETGBD success, including clinical and laboratory parameters, and gallbladder ultrasonograms, were also evaluated.


RESULTS
ETGBD was successful in seven of 11 patients (success rate 63.6%). All seven patients who underwent ETGBD successfully were afebrile and asymptomatic within a few days. No clinical or laboratory variables were significantly associated with the success of ETGBD. In contrast, ultrasonographic measures of gallbladder minor-axis length and wall thickness in successful cases were significantly shorter (27.4 mm versus 38.0 mm; P=0.008) and thinner (4.2 mm versus 9.0 mm; P=0.041) relative to unsuccessful cases.


CONCLUSIONS
Ultrasonographic measures of gallbladder minor-axis length and wall thickness can serve as important predictors of ETGBD technical difficulties during pretreatment evaluation of patients with acute cholecystitis.
Ogawa
Osamu
O
Showa University Fujigaoka Hospital, Aoba-ku, Yokohama, Japan. o-ogawa@showa-university-fujigaoka.gr.jp
Yoshikumi
Hiroki
H
Maruoka
Naotaka
N
Hashimoto
Yusuke
Y
Kishimoto
Yui
Y
Tsunamasa
Watanabe
W
Kuroki
Yuichiro
Y
Yasuda
Hiroshi
H
Endo
Yutaka
Y
Inoue
Kazuaki
K
Yoshiba
Makoto
M
D000368:Aged; D000369:Aged, 80 and over; D041881:Cholecystitis, Acute / Q000000981:diagnostic imaging / Q000601:surgery*; D004322:Drainage / Q000379:methods*; D016145:Endoscopy, Digestive System; D005260:Female; D005704:Gallbladder / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D014463:Ultrasonography