Endoscopic ultrasound-assisted transmural cholecystoduodenostomy or cholecystogastrostomy as a bridge for per-oral cholecystoscopy therapy using double-flanged fully covered metal stent

Abstract

BackgroundLaparoscopic cholecystectomy (LC) has become the ‘gold standard’ for the treatment of symptomatic gallstones. Innovative methods are being introduced, and these procedures include transgastric or transcolonic endoscopic cholecystectomy. However, before clinical implementation, instruments still need modification, and a more convenient treatment is still needed. Moreover, some gallbladders still have good functionality and cholecystectomy may be associated with various complications. The aim of this study was to evaluate the trans-gastrointestinal tract cholecystoscopy technique in the treatment of gallbladder disease without cholecystectomy.MethodEndoscopic ultrasound (EUS)-guided cholecystoduodenostomy or cholecystogastrostomy with the placement of a double-flanged fully covered metal stent was performed and endoscopic sphincterotomy (EST) was also performed during this procedure for those patients with accompanying common bile duct stones. One or two weeks later the stent was removed and an endoscope was advanced into the gallbladder via the fistula, and cholecystolithotomy or polyp resection was performed. Four weeks later gallbladder was assessed by abdominal ultrasound.ResultsEUS guided cholecystoduodenostomy (n = 3) or cholecystogastrostomy (n = 4) with double flanged mental stent deployment was successfully performed in all of 7 patients. After the procedure, fistulas had formed in each of the patients and the stents were removed. Endoscopic cholecystolithotomy(7) and polyps resection(2) were successfully performed through the fistulas. Common bile duct stones were also successfully removed in 5 patients. The ultrasound examination of the gallbladder 4 weeks later showed no stones remaining and also showed satisfactory functioning of the gallbladder.ConclusionThe EUS-guided placement of a novel metal stent is a safe and simple approach for performing an endoscopic cholecystoduodenostomy or cholecystogastrostomy, which can subsequently allow procedures to be performed for treating biliary disease, including cholecystolithotomy.

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

“…Some studies reported that EUS-GBD could be safer to perform than PTGBD in patients with anticoagulant therapy because the gastrointestinal tract is less vascular than the liver. 13,58 However, on the basis of our review, bleeding complications might occur with a certain probability, although they are rarely severe and fatal. 63…”

Current status of interventional endoscopic ultrasound

“…In their study, Barron and Topazian applied a plastic stent. Currently, however, reports on the deployment of the aforementioned lumen‐apposing metal stents have been increasing . Acute cholecystitis in cases of unresectable malignant biliary obstruction, a major complication of biliary SEMS placement, is regarded as a good indication for EUS‐GBD.…”

“…Currently, however, reports on the deployment of the aforementioned lumen-apposing metal stents have been increasing. [33][34][35][36][37][38] Acute cholecystitis in cases of unresectable malignant biliary obstruction, a major complication of biliary SEMS placement, is regarded as a good indication for EUS-GBD. The expected advantages of this technique compared to other procedures when treating acute cholecystitis are no risk of post-ERCP pancreatitis, internal drainage without the need for tube maintenance, less pain and burden on patients, and less chance of dislodgement or migration.…”

Endoscopic ultrasound-based transluminal cholecystolithotomy: the retrievable anchor assisted procedure

“…In 2012, we started an animal study and proved the feasibility and safety of EUS-guided transgastric cholecystolithotomy 2 . In 2015, we reported the initial attempt of EUS-assisted transduodenal cholecystolithotomy, 3 and then followed up with retrospective studies 4 , which all verified the feasibility of the technique. At that time, the procedure was accomplished by using a lumen apposing metal stent (LAMS) without a hot delivery system, which was assisted by the guidewire.…”