Endoscopic Gallbladder Drainage for Acute Cholecystitis

Abstract

Background/AimsSurgery is the mainstay of treatment for cholecystitis. However, gallbladder stenting (GBS) has shown promise in debilitated or high-risk patients. Endoscopic transpapillary GBS and endoscopic ultrasound-guided GBS (EUS-GBS) have been proposed as safe and effective modalities for gallbladder drainage.MethodsData from patients with cholecystitis were prospectively collected from August 2004 to May 2013 from two United States academic university hospitals and analyzed retrospectively. The following treatment algorithm was adopted. Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and cystic duct stenting was initially attempted. If deemed feasible by the endoscopist, EUS-GBS was then pursued.ResultsDuring the study period, 139 patients underwent endoscopic gallbladder drainage. Among these, drainage was performed in 94 and 45 cases for benign and malignant indications, respectively. Successful endoscopic gallbladder drainage was defined as decompression of the gallbladder without incidence of cholecystitis, and was achieved with ERCP and cystic duct stenting in 117 of 128 cases (91%). Successful endoscopic gallbladder drainage was also achieved with EUS-guided gallbladder drainage using transmural stent placement in 11 of 11 cases (100%). Complications occurred in 11 cases (8%).ConclusionsEndoscopic gallbladder drainage techniques are safe and efficacious methods for gallbladder decompression in non-surgical patients with comorbidities.

Efficacy and safety of endoscopic gallbladder drainage in acute cholecystitis: Is it better than percutaneous gallbladder drainage?

“…Eighteen studies (8, 16-25, 28, 30-33, 36, 37) (8,23,29,30,(32)(33)(34)38) were rated as high quality, 10 (17, 19, 21, 24, 25, 27, 28, 31, 35, 36) were of moderate quality, and 4 (16,18,20,22) were of low quality as per the NOS quality assessment. The 2 randomized studies (26,37) had lowrisk of bias as per the Cochran tool for assessing risk of bias.…”

“…Therefore a total of 66 full-text articles were reviewed, of which 23 studies (8, with 809 patients were included in the meta-analysis for primary outcomes of interest. One additional study (38) containing overlapping data with Widmer et al (33) was included in the secondary outcome of interest only. The search strategy is summarized in Figure 1.…”

Can percutaneous cholecystostomy be a definitive treatment in the elderly?

“…Recently, promising outcomes of endoscopic gallbladder drainage have been shown for ACC. 28,29 This might have a role in ACC and choledocholithiasis cases, as it could combine the drainage of the bile duct and the gallbladder in the same procedure, resulting in a decreased risk for patients. Nevertheless, there are still only a few reports in the literature about this topic, and further results from larger series are needed to define its role in the treatment of ACC.…”

Current Status in the Treatment of Acute Cholecystitis Patients Receiving Antithrombotic Therapy: Is Endoscopic Drainage Feasible?- A Systematic Review

“…As only 1 study on EGBD in patients receiving ATT was retrieved through the search method mentioned above, articles were additionally searched using the keywords "ETGBD" and "EUS-GBD". As a result, 27 studies on ETGBD 6,22-47 and 26 studies on EUS-GBD 8,37,40,45,46, were newly found. Finally, 28 studies on ETGBD and 26 studies on EUS-GBD were evaluated in this review, which included some cases with bleeding tendency and ATT administration.…”

“…Twenty-six studies 8,37,40,45,46, on EUS-GBD, including 1 RCT, 4 prospective studies, and 21 retrospective studies, were analyzed ( Table 3). The puncture sites were the duodenal bulb in 55% (334/609), the antrum in 44% (268/609), and the jejunum in 1% (7/609).…”