Gallbladder drainage guided by endoscopic ultrasound

Abstract

The gold-standard management of acute cholecystitis is cholecystectomy. Surgical intervention may be contraindicated due to permanent causes. To date, the classical approach is percutaneous cholecystostomy in patients unresponsive to medical therapy. However, with this treatment some patients may experience discomfort, complications and a decrease in their quality of life. In these cases, endoscopic ultrasound (EUS)-guided gallbladder drainage may represent an effective minimally invasive alternative. Our objective is to describe in detail this new and not well-known technique: EUS-guided cholecystenterostomy. We will describe how the patient should be prepared, what accessories are needed and how the technique is performed. We will also discuss the possible indications for this technique and will provide a brief review based on published reports and our own experience.

EUS-guided gallbladder drainage with a lumen-apposing metal stent (with video)

“…15 Stents (plastic and metal) can migrate into or out of the gallbladder. 14,19 LAMSs theoretically reduce both of these risks. No patient in our series experienced bile leakage or stent migration post-procedure.…”

Endoscopic ultrasound‐guided endoluminal drainage of the gallbladder

“…Based on the case series and reports in the medical literature, the indications for EUS‐GBD are summarized in Table . Additional potential indications based on our experience with EUS‐guided endoluminal drainage of collections are also listed.…”

“…This system is advantageous because it reduces the time that passes from the initial needle puncture until stent deployment, reducing the risk of loss of guidewire access and potential complications. However, this system is only available for 8.5‐ and 10‐Fr straight stents …”

“…A biliary dilation catheter (Soehendra; Cook Medical, Bloomington, IN, USA) was used as the initial dilating device in many reports . A triple‐lumen cystoenterostome (6‐ or 10‐Fr Cysto‐Gastro Set; Endo‐Flex, Voerde, Germany or Cystotome; Cook Medical) was another preferred dilation device that can assist in dilation using diathermy and/or a needle knife . A cystoenterostome has the advantage of carrying out dilation without lifting the ultrasound probe from the gut wall while diathermy causes melting of tissue and inflammatory reaction that can aid in keeping the tissue layers together .…”

“…Plastic biliary stents (PBS) were used in most early studies describing EUS‐GBD. A variety of PBS such as double pigtail, single pigtail and straight have been used with similar success rates (Table ) . Insertion of a plastic stent usually requires a tract diameter slightly larger than the stent to be placed, which could lead to a gap and potential leakage .…”