Drainage of Gallbladder Fossa Fluid Collections with Endoprosthesis Placement Under Endoscopic Ultrasound Guidance: A Preliminary Report of Two Cases

Abstract

Collections of fluid in the gallbladder fossa can be detected by ultrasound in as many as 29% of patients following cholecystectomy. Traditionally, persistent collections are treated by percutaneous drainage and bile duct decompression. We present two cases of persistent gallbladder fossa fluid collections which were refractory to bile duct decompression but which were successfully drained by endoscopic ultrasound-guided endoprosthesis placement. Under endoscopic ultrasound (EUS) control, a 19-gauge needle was inserted through the duodenal wall into the gallbladder fossa fluid collection. A guide wire was coiled within the collection, and an endoprosthesis was placed over the wire. Endoprosthesis insertion was successful in both cases, resulting in rapid symptomatic and radiographic improvement. EUS-guided drainage offers a minimally invasive alternative to percutaneous treatment of persistent gallbladder fossa fluid collections following cholecystectomy.

EUS-guided drainage and stent placement for postoperative intra-abdominal and pelvic fluid collections in oncological surgery

“…Since then, this procedure has been updated and improved [Vilmann et al 1998] which now means that EUS can be performed quickly, safely and in a controlled way. Cases that can now be considered as candidates for EUS with a minimal risk of bleeding or perforation include gallbladder collections [Kahaleh et al 2005], perirectal collections [Giovannini et al 2003], splenic abscesses [Lee et al 2006] and more recently bilomas [Shami et al 2008].…”

EUS-guided drainage of hepatic abscesses not accessible to percutaneous drainage (with videos)

“…[15][16][17][18][19][20][21][22][23][24][25][26][27] In the present study, we have provided a new indication of interventional EUS, including the first reported cases of EUS-guided drainage of hepatic abscesses in the caudate lobe not accessible to percutaneous drainage. There is a limitation on the general adaptation of EUSguided drainage for hepatic abscesses.…”

Endoscopic ultrasound‐guided endoluminal drainage of the gallbladder

“…The technique of EUS‐guided drainage has evolved over the past decade with drainage of extraluminal collections such as pancreatic pseudocysts, necrosis and abscesses . We have previously reported drainage of bilomas and gallbladder fossa fluid collections with success . Baron and Topazian first reported successful EUS‐guided transduodenal gallbladder drainage using double‐pigtail PBS in a patient with cholangiocarcinoma and bilateral metal biliary stents .…”

“…25,26 We have previously reported drainage of bilomas and gallbladder fossa fluid collections with success. 6,27 Baron and Topazian first reported successful EUS-guided transduodenal gallbladder drainage using double-pigtail PBS in a patient with cholangiocarcinoma and bilateral metal biliary stents. 19 Limited opposition of PBS with the tract wall led to bile leak and stent migration, 13,14 although it has been postulated that a thickened gallbladder wall and/or surrounding adhesions can decrease the risk of bile leak.…”