title: Endoscopic naso-gallbladder drainage versus gallbladder stenting before cholecystectomy in patients with acute cholecystitis and a high suspicion of choledocholithiasis: a prospective randomised preliminary study.
abstract: OBJECTIVE
  Endoscopic transpapillary gallbladder drainage using a nasocystic tube or plastic stent has been attempted as an alternative to percutaneous drainage for patients with acute cholecystitis who are not candidates for urgent cholecystectomy. We aimed to assess the efficacy of single-step endoscopic drainage of the common bile duct and gallbladder, and to evaluate which endoscopic transpapillary gallbladder drainage method is ideal as a bridge before elective cholecystectomy.
  
  
  METHODS
  From July 2011 to December 2014, 35 patients with acute moderate-to-severe cholecystitis and a suspicion of choledocholithiasis were randomly assigned to the endoscopic naso-gallbladder drainage (ENGBD) (n = 17) or endoscopic gallbladder stenting (EGBS) (n = 18) group.
  
  
  RESULTS
  Bile duct clearance was performed successfully in all cases. No significant differences were found between the ENGBD and EGBS groups in the technical success rates [82.4% (14/17) vs. 88.9% (16/18), p = 0.658] and clinical success rates [by intention-to-treat analysis: 70.6% (12/17) vs. 83.3% (15/18), p = 0.443; by per protocol analysis of technically feasible cases: 85.7% (12/14) vs. 93.8% (15/16), p = 0.586]. Three ENGBD patients and two EGBS patients experienced adverse events (p = 0.658). No significant differences were found in operation time or rate of conversion to open cholecystectomy.
  
  
  CONCLUSIONS
  Single-step endoscopic transpapillary drainage of the common bile duct and gallbladder seems to be an acceptable therapeutic modality in patients with acute cholecystitis and a suspicion of choledocholithiasis. There were no significant differences in the technical and clinical outcomes between ENGBD and EGBS as a bridge before cholecystectomy.
authors.affiliation: a Department of Gastroenterology , Ajou University School of Medicine , Suwon , South Korea ;
authors.forename: Min Jae
authors.initials: MJ
authors.lastname: Yang
authors.affiliation: a Department of Gastroenterology , Ajou University School of Medicine , Suwon , South Korea ;
authors.forename: Byung Moo
authors.initials: BM
authors.lastname: Yoo
authors.affiliation: a Department of Gastroenterology , Ajou University School of Medicine , Suwon , South Korea ;
authors.forename: Jin Hong
authors.initials: JH
authors.lastname: Kim
authors.affiliation: a Department of Gastroenterology , Ajou University School of Medicine , Suwon , South Korea ;
authors.forename: Jae Chul
authors.initials: JC
authors.lastname: Hwang
authors.affiliation: b Department of Surgery , Ajou University School of Medicine , Suwon , South Korea.
authors.forename: Nam Hyun
authors.initials: NH
authors.lastname: Baek
authors.affiliation: a Department of Gastroenterology , Ajou University School of Medicine , Suwon , South Korea ;
authors.forename: Soon Sun
authors.initials: SS
authors.lastname: Kim
authors.affiliation: a Department of Gastroenterology , Ajou University School of Medicine , Suwon , South Korea ;
authors.forename: Sun Gyo
authors.initials: SG
authors.lastname: Lim
authors.affiliation: b Department of Surgery , Ajou University School of Medicine , Suwon , South Korea.
authors.forename: Ji Hun
authors.initials: JH
authors.lastname: Kim
authors.affiliation: a Department of Gastroenterology , Ajou University School of Medicine , Suwon , South Korea ;
authors.forename: Sung Jae
authors.initials: SJ
authors.lastname: Shin
authors.affiliation: a Department of Gastroenterology , Ajou University School of Medicine , Suwon , South Korea ;
authors.forename: Jae Youn
authors.initials: JY
authors.lastname: Cheong
authors.affiliation: a Department of Gastroenterology , Ajou University School of Medicine , Suwon , South Korea ;
authors.forename: Kee Myung
authors.initials: KM
authors.lastname: Lee
authors.affiliation: a Department of Gastroenterology , Ajou University School of Medicine , Suwon , South Korea ;
authors.forename: Kwang Jae
authors.initials: KJ
authors.lastname: Lee
authors.affiliation: b Department of Surgery , Ajou University School of Medicine , Suwon , South Korea.
authors.forename: Wook Hwan
authors.initials: WH
authors.lastname: Kim
authors.affiliation: a Department of Gastroenterology , Ajou University School of Medicine , Suwon , South Korea ;
authors.forename: Sung Won
authors.initials: SW
authors.lastname: Cho
mesh_terms: D002763:Cholecystectomy; D041881:Cholecystitis, Acute / Q000150:complications* / Q000601:surgery*; D042883:Choledocholithiasis / Q000150:complications*; D004322:Drainage / Q000379:methods*; D004724:Endoscopy; D016145:Endoscopy, Digestive System; D005260:Female; D005704:Gallbladder / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009666:Nose; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D015607:Stents
keywords: Acute cholecystitis; choledocholithiasis; endoscopic gallbladder stenting; endoscopic naso-gallbladder drainage; endoscopic transpapillary gallbladder drainage