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Endoscopic ultrasound‐guided gallbladder drainage with a combined internal and external drainage tubes for acute cholecystitis
Author(s) -
Matsubara Saburo,
Isayama Hiroyuki,
Nakai Yousuke,
Kawakubo Kazumichi,
Yamamoto Natsuyo,
Saito Kei,
Saito Tomotaka,
Takahara Naminatsu,
Mizuno Suguru,
Kogure Hirofumi,
Ishizawa Takeaki,
Arita Junichi,
Hasegawa Kiyoshi,
Koike Kazuhiko
Publication year - 2020
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.15065
Subject(s) - medicine , cholecystitis , cholecystectomy , endoscopic ultrasound , surgery , gallbladder , stent , acute cholecystitis , melena , adverse effect , general surgery
Background and Aim Lumen‐apposing metal stent is widely used for endoscopic ultrasound‐guided gallbladder drainage (EUS‐GBD) nowadays but not approved in many countries and might be unsuitable for elective laparoscopic cholecystectomy (LC) because of its large enterocholecysto fistula. A combination of double pigtail plastic stent (DPPS) and naso‐cystic tube (NCT) could overcome these problems. The aim of this study was to estimate the efficacy and safety of this method in patients with acute cholecystitis unfit for urgent cholecystectomy both as bridge to surgery and palliation. Methods This was a prospective, single‐center feasibility study. EUS‐GBD was performed with a 7Fr DPPS followed by an NCT placement. NCT was removed after 1 week. LC was performed 2 or 3 months after EUS‐GBD in eligible patients. In patients who did not underwent cholecystectomy, DPPS was left in place. Results Twenty‐three patients were enrolled. Both technical and clinical success rates were 96% (22/23). Early adverse events rate was 13% (3/23), including one bile peritonitis, one intraperitoneal abscess, and one melena. LC was attempted in 12 patients, and conversion to open cholecystectomy was required in three (25%). Neither recurrence of cholecystitis nor late adverse event occurred during 6 months of follow up in 10 patients who did not undergo cholecystectomy. Conclusion EUS‐GBD with a combination of DPPS and NCT is considered an effective and safe technique both as bridge to surgery and palliation.