Endoscopic therapies for gallbladder drainage

Abstract

This document was reviewed and approved by the Governing Board of the American Society for Gastrointestinal Endoscopy.

Drenaje nasovesicular: alternativa endoscópica para la colecistitis aguda grave

“…El tratamiento de primera línea para la colecistitis aguda es la colecistectomía laparoscópica; sin embargo, en pacientes críticamente enfermos, la morbilidad y mortalidad postoperatoria aumentan, con tasas del 40% y del 5% respectivamente. 1,[15][16] En estos casos, el DP o simplemente la punción-aspiración de la vesícula biliar son los tratamientos estándar, que sirven como puente hasta la resolución quirúrgica definitiva. No obstante, en ciertas circunstancias, como en pacientes con coagulopatías, uso de anticoagulantes y antiplaquetarios, síndrome de Chilaiditi, ascitis, anormalidades anatómicas o falta de disponibilidad, el riesgo de complicaciones del DP, tales como hemorragia o peritonitis biliar, aumenta.…”

“…Sin embargo, hay consideraciones clínicas importantes para elegir entre estas opciones de tratamiento, que requieren un enfoque colaborativo multidisciplinario para el manejo terapéutico en estos pacientes. 15 Una de las mayores dificultades en el DE transpapilar es la canulación selectiva del conducto cístico. La presencia de litiasis cística, la dilatación del colédoco y la dirección del conducto cístico fueron reportadas como facto-Figura 7.…”

Transpapillary gallbladder stent placement remains a challenge for endoscopists

“…First, the majority of the patients included in the study had grade I or II (Tokyo grade) acute cholecystitis and may not have been suitable candidates for ERGD according to a recent study. 2 Meanwhile, ERGD with plastic double-pigtail stents may be challenging because of stent obstruction by purulent bile in some patients with severe acute cholecystitis, and endoscopic nasogallbladder drainage may be more appropriate because of the low rate of obstruction. Thus, it is still difficult to draw such a conclusion, inasmuch as some patients with severe acute cholecystitis were excluded because they were in medically unstable condition for ERCP with general anesthesia or monitored anesthesia care.…”

Acute cholecystitis: Which is the best therapeutic option?

“…PTGBD has traditionally been considered the alternative treatment of choice for nonsurgical drainage of the gallbladder, thanks to its widespread availability and the possibility that it can be performed in bedridden patients under local anesthesia or mild sedation. 4 Although the procedure is highly effective, it is burdened by significant morbidity. 5 Indeed, the presence of an external catheter requires continuous care, and its association with persistent pain has a negative effect on the patient's quality of life.…”

“…6 Moreover, this approach is preferred when the patient requires concomitant ERCP for choledocholithiasis or chol-angitis. 4 However, cannulation and insertion of a small 7F stent through the cystic duct can be challenging, particularly in the case of a long, narrow, or inflamed cystic duct with impacted stones. Technical success is therefore affected, being <90% even in expert hands.…”