Endoscopic Management of Gallbladder Stones: Can We Eliminate Cholecystectomy?

Abstract

The gold standard for the management of acute cholecystitis is laparoscopic cholecystectomy. In patients that are not fit for surgery, percutaneous cholecystostomy is the standard treatment. However, the procedure is only a temporary measure for controlling gallbladder symptoms and it is frequently associated with morbidities. Recently, endoscopic options for management of acute cholecystitis have been developed. The approach avoids the need for a percutaneous drain and may allow endoscopic treatment of the gallstone. The aim of this article is to provide an overview on the current status of endoscopic management of acute cholecystitis.

Current Status of Endoscopic Gallbladder Drainage

“…The gallbladder could be drained endoscopically using either the transpapillary or transmural approach [ 2 ]. In the transpapillary approach, a duodenoscope is used to cannulate the cystic duct via the common bile duct in a manner similar to endoscopic retrograde cholangiopancreatoscopy (ERCP).…”

“…The development of endoscopic GBD for treating acute cholecystitis began in the 1990s with endoscopic transpapillary (ETP) naso-cholecystic drainage [ 8 ]. The use of double pigtail stents to drain the gallbladder into the duodenum has also been described [ 2 ]. ETP-GBD omits the need for an external drain and thus avoids any drain-related adverse events.…”

“…The clinical success and adverse events rates were also comparable to PTC (ETP-GBD vs. PTC = 69.8% vs. 62.5% and 8.2% vs. 4.8%, respectively) [ 13 ]. To perform ETP-GBD, proficient skills in cannulation of the cystic duct are required, which may not always be conceivable [ 2 ]. Therefore, ETP-GBD may be preferred in treatment centers with a high level of expertise in ERCP in cases in which PTC is contraindicated, for example in severe coagulopathy, thrombocytopenia, or with an anatomically inaccessible position.…”

“…The gold standard for treating acute cholecystitis is laparoscopic cholecystectomy [ 1 ]. However, cholecystectomy is often not suitable for surgically unfit patients with advanced age, multiple comorbidities, or malignancies [ 2 ]. Percutaneous transhepatic cholecystostomy (PTC) is the standard method for drainage of the gallbladder in these patients.…”

Feasibility of the conversion of percutaneous cholecystostomy to internal transmural endoscopic ultrasound-guided gallbladder drainage

“…Therefore, endoscopic alternatives to gallbladder drainage have been developed. [ 2 ] These include endoscopic transpapillary gallbladder drainage and endoscopic ultrasound (EUS)-guided gallbladder drainage (EGBD). [ 3 4 5 6 7 ] Recently, EGBD is gaining popularity as the procedure of choice because multiple retrospective studies have shown that the procedure is associated with reduced risk of adverse events, unplanned admissions, and re-interventions compared to PTGBD.…”