title: Endosonography-guided gallbladder drainage for acute cholecystitis following covered metal stent deployment.
abstract: Endosonography-guided biliary drainage (ESBD) is gaining acceptance as an effective treatment for obstructive jaundice. Only a few reports on the application of this technique to the gallbladder (endosonography-guided gallbladder drainage [ESGBD]) have been published in the literature. In order to relieve acute cholecystitis which developed in a patient with unresectable malignant biliary obstruction after deployment of a covered metal stent (CMS), we applied this technique. ESGBD was carried out by using an electronic curved linear array echoendoscope. After visualization of the gallbladder and determination of the puncture route, a needle knife papillotome was advanced with electrocautery to pierce the gastric and gallbladder walls. Under the guidance of a guidewire inserted through the needle sheath into the gallbladder, a 7.2 Fr, 30 cm-long, single pigtail plastic tube was placed to bridge the gallbladder and the stomach. No complications relevant to the procedure were encountered. ESGBD was quite effective in ameliorating the patient's acute cholecystitis and the drainage tube was removed after 10 days without sequelae. Acute cholecystitis following CMS deployment is considered to be a good indication for ESGBD.
authors.affiliation: Department of Gastroenterology, Sendai City Medical Center, Miyagino-ku, Sendai, Japan. taka1@pm.highway.ne.jp
authors.forename: Osamu
authors.initials: O
authors.lastname: Takasawa
authors.forename: Naotaka
authors.initials: N
authors.lastname: Fujita
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Noda
authors.forename: Go
authors.initials: G
authors.lastname: Kobayashi
authors.forename: Kei
authors.initials: K
authors.lastname: Ito
authors.forename: Jun
authors.initials: J
authors.lastname: Horaguchi
authors.forename: Takashi
authors.initials: T
authors.lastname: Obana
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000556:secondary*; D041881:Cholecystitis, Acute / Q000209:etiology / Q000628:therapy*; D004322:Drainage; D019160:Endosonography; D005260:Female; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology / Q000628:therapy*; D010190:Pancreatic Neoplasms / Q000473:pathology*; D015607:Stents