Endoscopic transpapillary gallbladder drainage (ETGBD) for the treatment of acute cholecystitis

Abstract

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.

Endoscopic gallbladder drainage for management of acute cholecystitis

“…[15][16][17][18][19][20][21][22][24][25][26] The pooled technical success rate of the procedure in retrospective studies is 80.9% (95% CI, 74.7%-86.2%), which is lower than that reported for the percutaneous transhepatic approach. The pooled clinical response rate is 75.3% (95% CI, 68.6%-81.2%).…”

TG13 indications and techniques for gallbladder drainage in acute cholecystitis (with videos)

“…ENGBD can be used for patients with severe comorbid conditions, especially those with end‐stage liver disease, in whom the percutaneous approach is difficult to perform. However, because it requires a difficult endoscopic technique (technical success rate varies from 64 to 100 %), and relevant case‐series studies have been conducted only at a limited number of institutions [], ENGBD has not yet been established as a standard method. Therefore, it should be performed in high‐volume institutes by skilled endoscopists.…”

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.…”