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KMID : 1038120190520030262
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Clinical Endoscopy
2019 Volume.52 No. 3 p.262 ~ p.268
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Endoscopic Ultrasonography-Guided Gallbladder Drainage as a Treatment Option for Acute Cholecystitis after Metal Stent Placement in Malignant Biliary Strictures
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Kozakai Fumisato
Kanno Yoshihide
Ito Kei
Koshita Shinsuke
Ogawa Takahisa
Kusunose Hiroaki
Masu Kaori
Sakai Toshitaka
Murabayashi Toji
Yonamine Keisuke
Kawakami Yujiro
Fujii Yuki
Miyamoto Kazuaki
Noda Yutaka
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Abstract
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Background/Aims: It is often difficult to manage acute cholecystitis after metal stent (MS) placement in unresectable malignant biliary strictures. The aim of this study was to evaluate the feasibility of endoscopic ultrasonography-guided gallbladder drainage (EUS-GBD) for acute cholecystitis.
Methods: The clinical outcomes of 10 patients who underwent EUS-GBD for acute cholecystitis after MS placement between January 2011 and August 2018 were retrospectively evaluated. The procedural outcomes of percutaneous transhepatic gallbladder drainage (PTGBD) with tube placement (n=11 cases) and aspiration (PTGBA) (n=27 cases) during the study period were evaluated as a reference.
Results: The technical success and clinical effectiveness rates of EUS-GBD were 90% (9/10) and 89% (8/9), respectively. Severe bile leakage that required surgical treatment occurred in one case. Acute cholecystitis recurred after stent dislocation in 38% (3/8) of the cases. Both PTGBD and PTGBA were technically successful in all cases without severe adverse events and clinically effective in 91% and 63% of the cases, respectively.
Conclusions: EUS-GBD after MS placement was a feasible option for treating acute cholecystitis. However, it was a rescue technique following the established percutaneous intervention in the current setting because of the immature technical methodology, including dedicated devices, which need further development.
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KEYWORD
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Unresectable malignant biliary stricture, Acute cholecystitis, Endscopic ultrasonography-guided gallbladder drainage, Percutaneous transhepatic gallbladder drainage, Percutaneous transhepatic gallbladder aspiration
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