Percutaneous cholecystostomy as a bridge to definitive endoscopic gallbladder stent placement.
OBJECTIVE
Percutaneous cholecystostomy (PC) is an effective treatment for acute cholecystitis (AC) in patients who are poor surgical candidates, although it is generally used as a bridge to cholecystectomy, given its long-term risks, the need for repeated procedures, and patient dissatisfaction. Ongoing patient comorbidity, however, might preclude cholecystectomy after recovery from the acute illness.


METHODS
Four patients with AC who were poor immediate and long-term candidates for cholecystectomy underwent PC as primary therapy for AC, followed by endoscopic placement of a transpapillary gallbladder stent as definitive long-term management.


RESULTS
All 4 patients were successfully treated for AC with PC. After recovery, the patients underwent endoscopic gallbladder stent placement and removal of the PC. In 2 cases, endoscopic transpapillary access to the gallbladder was facilitated by advancing a guidewire through the cholecystostomy tract into the duodenum. All patients had favorable outcomes.


CONCLUSIONS
PC as a bridge to permanent therapy with endoscopic gallbladder stenting appears to be a viable strategy in the management of patients with AC who are poor immediate and long-term candidates for cholecystectomy.
Division of Gastroenterology, University of Michigan Medical Center, Ann Arbor, MI, USA. badihe@umich.edu
B Joseph
BJ
Elmunzer
Paula M
PM
Novelli
Jason R
JR
Taylor
Cyrus R
CR
Piraka
James J
JJ
Shields
D000328:Adult; D000369:Aged, 80 and over; D041881:Cholecystitis, Acute / Q000601:surgery*; D002767:Cholecystostomy / Q000379:methods*; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D005704:Gallbladder / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D016896:Treatment Outcome