Placement of the stent above the intact sphincter of Oddi was associated with longer stent patency and lower occlusion rate.

For the treatment of acute cholecystitis that does not react to conservative therapies, PTGBA is a safe, simple, and effective treatment modality that can be performed at bedside without any severe complications.

We performed endoscopic transpapillary gallbladder drainage (ETGBD) in 21 patients with acute cholecystitis, utilizing a guidewire coated with a hydrophilic polymer. Endoscopic sphincterotomy was not performed. The clinical efficacy of ETGBD was evaluated in terms of reduction of white blood cell count (WBC) and C-reactive protein (CRP) level. ETGBD was successful in ~.7 (81%) of the 21 patients, in terms of early disappearance of clinical symptoms, and significant decrease of both WBC and CRP after ETGBD (P < 0.001). in patients with the Mirizzi syndrome (n = 2), accurate diagnosis was made by endoscopic retrograde cholangiography (ERC), facilitating proper drainage (ETGBD) immediately afterward. With ETGBD, emergency operation was avoided even in critically ill patients complicated with disseminated intravascular coagulopathy (n = 2). There were no significant complications. ETGBD may be an effective and safe alternative to percutaneous transhepatic gallbladder drainage in the management of acute cholecystitis, and may be more suitable for patients with a strong bleeding tendency.

Although further studies with a large number of patients are needed to evaluate the efficacy of the papillotome, this papillotome may contribute to increase the safety and the success rate of precutting.

No abstract