Endoscopic Drainage of Acute Obstructive Cholecystitis in Patients with Increased Operative Risk

Abstract

Emergency biliary surgery for acute obstructive cholecystitis in the elderly is associated with an increased hospital mortality. We therefore attempted to drain the obstructed gallbladder via the transpapillary route in 18 patients (mean age: 67 years) who had cystic duct obstruction on ERC and who were at an increased surgical risk. A cholecystonasal catheter was successfully introduced after a small EPT in sixteen of them (89%). This resulted in effective bile drainage, obviating the need for emergency surgery in all patients. No procedure-associated morbidity or mortality was found. Following clinical remission, elective treatment consisted of ESWL/direct stone dissolution (n = 10) or elective surgery (n = 3). Three patients received no further therapy. Our results show that endoscopic gallbladder drainage may be a valuable alternative to emergency surgery in high risk patients with acute obstructive cholecystitis.

Endoscopic gallbladder drainage for management of acute cholecystitis

“…[15][16][17][18][19][20][21][22][24][25][26] The pooled technical success rate of the procedure in retrospective studies is 80.9% (95% CI, 74.7%-86.2%), which is lower than that reported for the percutaneous transhepatic approach. The pooled clinical response rate is 75.3% (95% CI, 68.6%-81.2%).…”

Laparoscopic cholecystectomy in 226 cirrhotic patients

“…A considerable body of evidence supports the use of ERCP in high-risk patients who present with biliary obstruction. Also, endoscopic drainage of the gallbladder has been performed in some cases but remains uncommon [9,20]. Alternatively, percutaneous cholecystostomy may reverse the progression of inammation in patients with cholecystitis and provides prompt symptomatic relief [12].…”

Laparoscopic cholecystectomy and cirrhosis: A case-control study of outcomes

“…Endoscopic drainage of the gallbladder has been added in some cases but remains an uncommon procedure. 25,26 Alternatively, percutaneous cholecystostomy may reverse the progression of inflammation in patients with cholecystitis and often provides prompt symptomatic relief. 27 However, in the presence of portal hypertension and/or ascites, its use is also associated with hemorrhage or sepsis.…”