Endoscopic Retrograde Cholangiopancreatography Treatment of Cholecystitis: Possible? Yes; Practical??

Abstract

Classically, until now, the management of cholecystitis has consisted of immediate and judicious clinical assessment of the affected patient, interpolating into the assessment of the physical findings and results from appropriate laboratory, x-ray, and scanning techniques (sonography and scintigraphy) to formulate a clinical impression. Usually, after the diagnosis has been established, the patient is subjected to a cholecystectomy, although the timing of the surgery may vary depending on the clinical condition of the patient. Alternatives to this management (eholecystectomy, medical management) scheme have been suggested, but these are dependent upon the clinical condition ofthe patient and considerations of risks. Percutaneous drainage of the gallbladder or cholecystostomy is sufficient enough to provide drainage, relieve obstruction, and the consequences of infection, i.e., sepsis, and prevent perforation. A contributory role of endoscopic retrograde cholangiopancreatography (ERCP) in this schema has not been a consideration. An ERCP is rarely employed for therapy (or diagnosis) when cholecystitis is suspected but it might assume a more significant role if it is considered an efficacious alternative in specific conditions. We have had the unusual experience of managing 11 patients with cholecystitis employing ERCP and its therapeutic modalities, i.e., sphincterotomy, selective cannulation of the cystic duck and relieving obstruction of that structure by catheter displacement of an obstructing stone. Endoscopic techniques providing decompression of the gallbladder are discfibed, and the feasibility of utilizing endoscopic procedures for treatment of cholecystitis will be given consideration.

Biliary tract diseases in the elderly: management and outcomes

“…Cholecystitis, which is a consequence of stones impacted in the cystic duct, is such an example. Stones can be dislodged by vigorously injecting contrast material into the cystic duct or by manipulating the obstructing stone with catheters and guidewires 5. Transpapillary stents can be placed into the affected gall bladder via the cystic duct, allowing bile and purulent material to drain into the duodenum thus palliating acute cholecystitis.…”

Long-Term Outcomes of Endoscopic Gallbladder Drainage for Cholecystitis in Poor Surgical Candidates: An Updated Comprehensive Review

“…ENGBD and EGBS are classified as transpapillary approaches; a naso-gallbladder tube is placed in ENGBD and a plastic stent extending from the gallbladder to the duodenum is placed in EGBS [ 9 ]. Since EGBS is an internal fistula method, the tube can be indwelling for a long period of time without impairing a patient’s quality of life; in fact, long-term placement can be useful in preventing cholecystitis recurrence in patients with end-stage liver disease [ 10 , 11 , 12 ] and poor surgical candidates [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ] ( Figure 1 ). Based on research surrounding biliary stent placement for malignant or benign biliary strictures, it is unlikely that the stent will remain patent for years [ 27 , 28 ].…”

Role of ERCP in the Older Adults

“…In patients with acute calculous cholecystitis, stones can be dislodged by vigorously injecting contrast material into the cystic duct or by manipulating the obstructing stone with catheters and guidewires (Siegel et al 1994). Trans-papillary stents can be placed into the affected gall bladder via the cystic duct establishing free flow of bile and purulent material to drain into the duodenum thus palliating acute cholecystitis.…”