Endoscopic Transpapillary Gallbladder Drainage for Recurrent Cholecystitis after Covered Self-expandable Metal Stent Placement for Unresectable Malignant Biliary Obstruction

Abstract

A 76-year-old woman with advanced pancreatic cancer developed recurrent cholecystitis after covered selfexpandable metal stent (CSEMS) placement. The cholecystitis was refractory to repeated percutaneous transhepatic gallbladder drainage (PTGBD). Cholecystography showed a patent cystic duct with right and cranial side bifurcation, which is indicative of an increased likelihood of success of endoscopic transpapillary gallbladder drainage (ETGBD). We were able to manage the cholecystitis by ETGBD without further recurrence. ETGBD is considered an effective internal drainage method for the management of acute cholecystitis after CSEMS placement, and its indication may be decided on the basis of the findings of cholecystography through the PTGBD route.

How should a therapeutic strategy be constructed for acute cholecystitis after self-expanding metal stent placement for malignant biliary obstruction?

“…ETGBD is an endoscopic retrograde cholangiopancreatography-related procedure in which a drainage tube is placed into the gallbladder via the cholecystic duct in a trans-papillary fashion. 5 Although much has been reported regarding the usefulness of this technique, it is generally difficult to perform due to the many variants of cholecystic duct anatomy.…”