title: Endoscopic ultrasound-assisted transmural cholecystoduodenostomy or cholecystogastrostomy as a bridge for per-oral cholecystoscopy therapy using double-flanged fully covered metal stent.
abstract: BACKGROUND
  Laparoscopic cholecystectomy (LC) has become the 'gold standard' for the treatment of symptomatic gallstones. Innovative methods are being introduced, and these procedures include transgastric or transcolonic endoscopic cholecystectomy. However, before clinical implementation, instruments still need modification, and a more convenient treatment is still needed. Moreover, some gallbladders still have good functionality and cholecystectomy may be associated with various complications. The aim of this study was to evaluate the trans-gastrointestinal tract cholecystoscopy technique in the treatment of gallbladder disease without cholecystectomy.
  
  
  METHODS
  Endoscopic ultrasound (EUS)-guided cholecystoduodenostomy or cholecystogastrostomy with the placement of a double-flanged fully covered metal stent was performed and endoscopic sphincterotomy (EST) was also performed during this procedure for those patients with accompanying common bile duct stones. One or two weeks later the stent was removed and an endoscope was advanced into the gallbladder via the fistula, and cholecystolithotomy or polyp resection was performed. Four weeks later gallbladder was assessed by abdominal ultrasound.
  
  
  RESULTS
  EUS guided cholecystoduodenostomy (n = 3) or cholecystogastrostomy (n = 4) with double flanged mental stent deployment was successfully performed in all of 7 patients. After the procedure, fistulas had formed in each of the patients and the stents were removed. Endoscopic cholecystolithotomy(7) and polyps resection(2) were successfully performed through the fistulas. Common bile duct stones were also successfully removed in 5 patients. The ultrasound examination of the gallbladder 4 weeks later showed no stones remaining and also showed satisfactory functioning of the gallbladder.
  
  
  CONCLUSIONS
  The EUS-guided placement of a novel metal stent is a safe and simple approach for performing an endoscopic cholecystoduodenostomy or cholecystogastrostomy, which can subsequently allow procedures to be performed for treating biliary disease, including cholecystolithotomy.
authors.affiliation: Endoscopy Center, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang, Liaoning Province, 110004, China.
authors.forename: Nan
authors.initials: N
authors.lastname: Ge
authors.affiliation: Endoscopy Center, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang, Liaoning Province, 110004, China. Sunsy@sj-hospital.org.
authors.forename: Siyu
authors.initials: S
authors.lastname: Sun
authors.affiliation: Anesthesia Department, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang, Liaoning Province, 110004, China.
authors.forename: Shiwei
authors.initials: S
authors.lastname: Sun
authors.affiliation: Endoscopy Center, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang, Liaoning Province, 110004, China.
authors.forename: Sheng
authors.initials: S
authors.lastname: Wang
authors.affiliation: Endoscopy Center, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang, Liaoning Province, 110004, China.
authors.forename: Xiang
authors.initials: X
authors.lastname: Liu
authors.affiliation: Endoscopy Center, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang, Liaoning Province, 110004, China.
authors.forename: Guoxin
authors.initials: G
authors.lastname: Wang
mesh_terms: D000005:Abdomen / Q000000981:diagnostic imaging; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D002767:Cholecystostomy / Q000295:instrumentation / Q000379:methods*; D004322:Drainage / Q000295:instrumentation* / Q000379:methods; D004385:Duodenostomy / Q000295:instrumentation / Q000379:methods*; D019160:Endosonography / Q000379:methods; D005260:Female; D005704:Gallbladder / Q000000981:diagnostic imaging / Q000601:surgery; D005705:Gallbladder Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D042882:Gallstones / Q000000981:diagnostic imaging / Q000601:surgery; D005774:Gastrostomy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D000069322:Self Expandable Metallic Stents; D016717:Sphincterotomy, Endoscopic / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*