BACKGROUND: The cornerstone of management for acute cholecystitis is cholecystectomy. However, surgical intervention is contraindicated in the occasional patient. EUS-guided transduodenal gallbladder drainage may represent an effective minimally invasive alternative. OBJECTIVES: To describe a new technique, EUS-guided cholecystenterostomy. DESIGN AND SETTING: A single-center retrospective case series. PATIENTS: Three patients with severe acute cholecystitis unresponsive to conservative management who were deemed unfit for cholecystectomy. INTERVENTIONS: Under combined EUS and fluoroscopic guidance, cholecystenterostomy was performed via needle puncture, guidewire insertion, cystoenterostome passage, and stent placement. MAIN OUTCOME MEASURES: Technical success, clinical progress, immediate and long-term complications, and recurrence of cholecystitis. LIMITATIONS: Pilot series. RESULTS: Cholecystenterostomy was performed successfully in all patients. Rapid improvement in clinical status and inflammatory parameters ensued. A minor intraprocedural bile leak occurred in 1 patient, without significant clinical sequelae. Cholecystitis did not recur in any patient. CONCLUSIONS: EUS-guided cholecystenteric drainage is technically feasible and appears to be a safe and effective procedure. Via this technique, gallbladder drainage and resolution of related sepsis may be achieved in patients with acute cholecystitis who are unfit for surgery.
BACKGROUND: The cornerstone of management for acute cholecystitis is cholecystectomy. However, surgical intervention is contraindicated in the occasional patient. EUS-guided transduodenal gallbladder drainage may represent an effective minimally invasive alternative. OBJECTIVES: To describe a new technique, EUS-guided cholecystenterostomy. DESIGN AND SETTING: A single-center retrospective case series. PATIENTS: Three patients with severe acute cholecystitis unresponsive to conservative management who were deemed unfit for cholecystectomy. INTERVENTIONS: Under combined EUS and fluoroscopic guidance, cholecystenterostomy was performed via needle puncture, guidewire insertion, cystoenterostome passage, and stent placement. MAIN OUTCOME MEASURES: Technical success, clinical progress, immediate and long-term complications, and recurrence of cholecystitis. LIMITATIONS: Pilot series. RESULTS: Cholecystenterostomy was performed successfully in all patients. Rapid improvement in clinical status and inflammatory parameters ensued. A minor intraprocedural bile leak occurred in 1 patient, without significant clinical sequelae. Cholecystitis did not recur in any patient. CONCLUSIONS: EUS-guided cholecystenteric drainage is technically feasible and appears to be a safe and effective procedure. Via this technique, gallbladder drainage and resolution of related sepsis may be achieved in patients with acute cholecystitis who are unfit for surgery.
Authors: Carlo Fabbri; Carmelo Luigiano; Andrea Lisotti; Vincenzo Cennamo; Clara Virgilio; Giancarlo Caletti; Pietro Fusaroli Journal: World J Gastroenterol Date: 2014-07-14 Impact factor: 5.742