title: Feasibility and safety of EUS-guided transgastric/transduodenal gallbladder drainage with single-step placement of a modified covered self-expandable metal stent in patients unsuitable for cholecystectomy.
abstract: BACKGROUND
  Although early laparoscopic cholecystectomy is the treatment of choice for patients with acute cholecystitis, percutaneous cholecystostomy has been performed in patients unsuitable for cholecystectomy. EUS-guided transgastric/transduodenal gallbladder drainage by using a plastic stent and/or nasobiliary drainage may be an alternative effective treatment for these patients, but bile leakage into the peritoneal space causing bile peritonitis is not uncommon during placement of a plastic stent.
  
  
  OBJECTIVE
  To evaluate the technical feasibility and safety of EUS-guided transgastric/transduodenal gallbladder drainage with single-step placement of a modified covered self-expandable metal stent (CSEMS) in patients with acute cholecystitis who are unsuitable for cholecystectomy.
  
  
  METHODS
  Prospective feasibility study.
  
  
  METHODS
  Tertiary-care referral center.
  
  
  METHODS
  This study involved 15 patients with acute cholecystitis who did not respond to initial medical treatment and were unsuitable for cholecystectomy.
  
  
  METHODS
  EUS-guided transgastric/transduodenal gallbladder drainage with single-step placement of a modified CSEMS.
  
  
  METHODS
  Technical success, functional success, complications associated with the placement of a metal stent, and recurrence of acute cholecystitis.
  
  
  RESULTS
  Modified CSEMSs were successfully placed in all patients through the stomach (n = 10) or duodenum (n = 5). All patients achieved functional success within 3 days of metal stent placement. Pneumoperitoneum occurred in two patients during or after the procedure, but both patients improved with conservative management. During follow-up (median 145 days, range 60-297 days), no patient experienced recurrent cholecystitis.
  
  
  CONCLUSIONS
  Small patient population without long-term follow-up.
  
  
  CONCLUSIONS
  Placement of a modified CSEMS after EUS-guided transgastric/transduodenal gallbladder drainage may be a feasible and safe alternative to treatments such as percutaneous cholecystostomy in patients with acute cholecystitis who are unsuitable for cholecystectomy.
authors.affiliation: Department of Gastroenterology, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Ji Woong
authors.initials: JW
authors.lastname: Jang
authors.forename: Sang Soo
authors.initials: SS
authors.lastname: Lee
authors.forename: Do Hyun
authors.initials: DH
authors.lastname: Park
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: D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy; D041881:Cholecystitis, Acute / Q000601:surgery*; D002767:Cholecystostomy / Q000295:instrumentation / Q000379:methods*; D004322:Drainage; D004386:Duodenum / Q000601:surgery; D019160:Endosonography; D005240:Feasibility Studies; D005260:Female; D005704:Gallbladder / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015607:Stents; D013270:Stomach / Q000601:surgery; D016896:Treatment Outcome