Factors affecting technical success of endoscopic transpapillary gallbladder drainage for acute cholecystitis

Abstract

Background/PurposeEndoscopic transpapillary gallbladder drainage (ETGBD), including endoscopic nasogallbladder drainage (ENGBD) and endoscopic gallbladder stenting (EGBS), has been reported to be an effective treatment for acute cholecystitis. However, ETGBD is considered to be more difficult than percutaneous transhepatic gallbladder drainage (PTGBD), and few studies have evaluated the factors that affect technical success of the procedure. We investigated the factors predicting its technical success from among patient characteristics and image findings before treatment.MethodsThree hundred twenty three patients who underwent ETGBD for acute cholecystitis from November 2006 to December 2018 were analyzed retrospectively.ResultsThe technical success rate was 72.8% (235/323). The technical success rate by cystic duct direction was as follows: proximal/distal, 65.9%/93.6%; right/left: 74.0%/65.2%; cranial/caudal, 83.5%/20.0%. The clinical response rate was 96.2% (226/235). Adverse events were encountered in 5.9% of cases (19/323), including cystic duct injury (11 patients), pancreatitis (five patients), and bleeding (three patients). In both univariate and multivariate analysis, presence of cystic duct stone, dilation of the common bile duct (CBD), and cystic duct direction (proximal and caudal branches) were identified as significant factors affecting technical failure of ETGBD.ConclusionAlthough ETGBD was an effective and safe procedure for acute cholecystitis, it has a limited success rate. The presence of cystic duct stone, dilation of CBD, and cystic duct direction (proximal and caudal branches) can serve as important predictors of ETGBD difficulties. These findings should be considered before procedures and the necessary adaptation of ETGBD made.

The Influence of Pre-Procedural Imaging and Cystic Duct Cholangiography on Endoscopic Transpapillary Gallbladder Drainage in Acute Cholecystitis

“…According to previous reports, the most common cystic duct directions and locations are the proximal, right, and cranial branches [ 15 ]. Maruta et al reported that the cystic duct showed proximal, right, and cranial branches in 76%, 86%, and 80% of the cases, respectively, which is similar to our results [ 16 ]. However, no previous reports have described the diagnostic imaging ability of cystic duct anatomy in patients with acute cholecystitis before performing ETGBD.…”

Endoscopic transpapillary gallbladder drainage for management of acute cholecystitis with coagulopathy

“…In terms of procedural skills, several considerations are needed. First, according to a recent study, 9 the presence of cystic duct stones, dilation of the common bile duct, and the direction of the cystic duct (proximal and caudal branches) are regarded as important predictors of ETGBD difficulties. Therefore, preoperative magnetic resonance cholangiopancreatography or computed tomography is recommended to observe the location and direction of the confluence of the cystic duct and common bile duct, which is conducive to superselection of the cystic duct.…”

Clinical Evaluation of a Newly Developed Guidewire for Pancreatobiliary Endoscopy

“…Endoscopic transpapillary gallbladder drainage has been reported to be effective, but the success rate varies from 50% to 100% because of difficulties in establishing a passage through ducts [10][11][12][13]. Of the 30 cholecystitis procedures, 12 were completed with the original GW and the original manipulator.…”