title: EUS-guided cholecystoenterostomy with single-step placement of a 7F double-pigtail plastic stent in patients who are unsuitable for cholecystectomy: a pilot study (with video).
abstract: BACKGROUND
  Although the definitive therapy of acute cholecystitis is cholecystectomy, nonsurgical treatment such as percutaneous cholecystostomy could be indicated in patients who are unsuitable candidates for cholecystectomy. EUS-guided cholecystoenterostomy with a plastic stent and/or nasobiliary drainage has been proposed as an alternative effective treatment for these patients.
  
  
  OBJECTIVE
  We conducted this study to evaluate the technical feasibility, safety, usefulness, and follow-up results of EUS-guided cholecystoenterostomy with single-step placement of a plastic stent for patients with acute cholecystitis who are unsuitable candidates for cholecystectomy.
  
  
  METHODS
  A prospective feasibility study with a case series.
  
  
  METHODS
  Tertiary teaching hospital.
  
  
  METHODS
  Eight consecutive patients diagnosed with acute cholecystitis who were poor candidates for surgery.
  
  
  METHODS
  EUS-guided cholecystoenterostomy with single-step placement of a 7F double-pigtail plastic stent.
  
  
  METHODS
  Technical success, clinical resolution of acute cholecystitis, procedure-related complications, and recurrence of cholecystitis.
  
  
  RESULTS
  Technical success and clinical resolution were achieved in all patients (100% [8/8] as intent to treat). A transduodenal approach was used for 7 patients and a transgastric approach for 1 patient. One patient showed self-limited pneumoperitoneum, and bile peritonitis occurred in 1 patient. One patient showed distal stent migration without bile leakage 3 weeks after stent insertion. During follow-up periods (median 186 days; range 22-300 days), cholecystitis did not recur in any patients.
  
  
  CONCLUSIONS
  Small number of patients.
  
  
  CONCLUSIONS
  EUS-guided cholecystoenterostomy with single-step placement of a 7F double-pigtail plastic stent may be a feasible and useful alternative in patients with acute cholecystitis who are unsuitable candidates for cholecystectomy.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Tae Jun
authors.initials: TJ
authors.lastname: Song
authors.forename: Do Hyun
authors.initials: DH
authors.lastname: Park
authors.forename: Jun Bum
authors.initials: JB
authors.lastname: Eum
authors.forename: Sung-Hoon
authors.initials: SH
authors.lastname: Moon
authors.forename: Sang Soo
authors.initials: SS
authors.lastname: Lee
authors.forename: Dong Wan
authors.initials: DW
authors.lastname: Seo
authors.forename: Sung Koo
authors.initials: SK
authors.lastname: Lee
authors.forename: Myung-Hwan
authors.initials: MH
authors.lastname: Kim
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002764:Cholecystitis / Q000628:therapy*; D002767:Cholecystostomy / Q000379:methods*; D019160:Endosonography; D004766:Enterostomy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011474:Prosthesis Design; D015607:Stents; D014741:Video Recording