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).
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.
Song
Tae Jun
TJ
Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
Park
Do Hyun
DH
Eum
Jun Bum
JB
Moon
Sung-Hoon
SH
Lee
Sang Soo
SS
Seo
Dong Wan
DW
Lee
Sung Koo
SK
Kim
Myung-Hwan
MH
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