Endoscopic ultrasound‐guided endoluminal drainage of the gallbladder

Abstract

For patients with acute cholecystitis who are not suitable for surgery, endoscopic ultrasound-guided endoluminal drainage of the gallbladder (EUS-GBD) has been developed to overcome the limitations of percutaneous transhepatic gallbladder drainage when endoscopic transpapillary gallbladder drainage is not feasible. In the present review we have summarized the studies describing EUS-GBD. Indications, techniques, accessories, endoprostheses, limitations and complications reported in the different studies are discussed. There were 90 documented cases in the literature. The overall reported technical success rate was 87/90 (96.7%). All patients with technical success were clinically successful. A total of 11/90 (12.2%) patients had complications including pneumoperitoneum, bile peritonitis and stent migration. The advantage of EUS-GBD is its ability to provide gallbladder drainage especially in situations where percutaneous or transpapillary drainage is not feasible or is technically challenging. It also provides the option of internal drainage and the ability to carry out therapeutic maneuvers via cholecystoscopy.

EUS-guided gallbladder drainage with a lumen-apposing metal stent (with video)

“…10,13,14 PT-GBD, the current standard treatment for nonsurgical patients with acute cholecystitis, has high clinical success rates. [4][5][6][7] However, contraindications include coagulopathy, perihepatic ascites, [14][15][16] and intervening bowel loops. 16 The advantages of EUS-GBD over PT-GBD include internalization of bile 17 and less postprocedure pain.…”

“…18 EUS-GBD might also reduce the risk of bleeding, given the tract to the bowel is less vascularized than the liver. 15,16 Since its first description in 2007, 13 EUS-GBD has been performed by using pigtail plastic biliary stents, nasobiliary catheters, covered self-expandable metal stents, and, most recently, LAMSs. 10 Self-expandable metal stents have an advantage over plastic stents because of their ability to seal the gap between the stent and the gallbladder wall, theoretically reducing bile leaks.…”

“…10 Self-expandable metal stents have an advantage over plastic stents because of their ability to seal the gap between the stent and the gallbladder wall, theoretically reducing bile leaks. 15 Stents (plastic and metal) can migrate into or out of the gallbladder. 14,19 LAMSs theoretically reduce both of these risks.…”

Usefulness of endoscopic ultrasound-guided fine needle aspiration in the diagnosis of hepatic, gallbladder and biliary tract Lesions

“…been reported and is technically successful for the management of acute cholecystitis in high risk patients [59][60][61] . Table 2 summarizes the sensitivity, specificity and diagnostic accuracy in the reported studies.…”

Endoscopic ultrasonography‐guided gallbladder drainage procedures: Is the glass half‐full or half‐empty?

“…Its application has now expanded to include drainage of obstructive pancreatic and biliary ductal systems not accessible by endoscopic retrograde cholangiopancreatography (ERCP) . More recently, the range of its applications has been widened to include gallbladder drainage in poor‐risk surgical candidates with gallbladder disease . This is particularly relevant for patients in whom transpapillary and percutaneous approaches to gallbladder drainage has failed or is technically difficult.…”