BACKGROUND: Although the definitive therapy of acute cholecystitis is cholecystectomy, nonsurgical treatment such as percutaneous cholecystostomy could be indicated in patients who are unsuitable candidates for cholecystectomy. EUS-guided cholecystoenterostomy with a plastic stent and/or nasobiliary drainage has been proposed as an alternative effective treatment for these patients. OBJECTIVE: We conducted this study to evaluate the technical feasibility, safety, usefulness, and follow-up results of EUS-guided cholecystoenterostomy with single-step placement of a plastic stent for patients with acute cholecystitis who are unsuitable candidates for cholecystectomy. DESIGN: A prospective feasibility study with a case series. SETTING: Tertiary teaching hospital. PATIENTS: Eight consecutive patients diagnosed with acute cholecystitis who were poor candidates for surgery. INTERVENTIONS: EUS-guided cholecystoenterostomy with single-step placement of a 7F double-pigtail plastic stent. MAIN OUTCOME MEASUREMENTS: Technical success, clinical resolution of acute cholecystitis, procedure-related complications, and recurrence of cholecystitis. RESULTS: Technical success and clinical resolution were achieved in all patients (100% [8/8] as intent to treat). A transduodenal approach was used for 7 patients and a transgastric approach for 1 patient. One patient showed self-limited pneumoperitoneum, and bile peritonitis occurred in 1 patient. One patient showed distal stent migration without bile leakage 3 weeks after stent insertion. During follow-up periods (median 186 days; range 22-300 days), cholecystitis did not recur in any patients. LIMITATIONS: Small number of patients. CONCLUSION: EUS-guided cholecystoenterostomy with single-step placement of a 7F double-pigtail plastic stent may be a feasible and useful alternative in patients with acute cholecystitis who are unsuitable candidates for cholecystectomy. 2010 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.
BACKGROUND: Although the definitive therapy of acute cholecystitis is cholecystectomy, nonsurgical treatment such as percutaneous cholecystostomy could be indicated in patients who are unsuitable candidates for cholecystectomy. EUS-guided cholecystoenterostomy with a plastic stent and/or nasobiliary drainage has been proposed as an alternative effective treatment for these patients. OBJECTIVE: We conducted this study to evaluate the technical feasibility, safety, usefulness, and follow-up results of EUS-guided cholecystoenterostomy with single-step placement of a plastic stent for patients with acute cholecystitis who are unsuitable candidates for cholecystectomy. DESIGN: A prospective feasibility study with a case series. SETTING: Tertiary teaching hospital. PATIENTS: Eight consecutive patients diagnosed with acute cholecystitis who were poor candidates for surgery. INTERVENTIONS: EUS-guided cholecystoenterostomy with single-step placement of a 7F double-pigtail plastic stent. MAIN OUTCOME MEASUREMENTS: Technical success, clinical resolution of acute cholecystitis, procedure-related complications, and recurrence of cholecystitis. RESULTS: Technical success and clinical resolution were achieved in all patients (100% [8/8] as intent to treat). A transduodenal approach was used for 7 patients and a transgastric approach for 1 patient. One patient showed self-limited pneumoperitoneum, and bile peritonitis occurred in 1 patient. One patient showed distal stent migration without bile leakage 3 weeks after stent insertion. During follow-up periods (median 186 days; range 22-300 days), cholecystitis did not recur in any patients. LIMITATIONS: Small number of patients. CONCLUSION: EUS-guided cholecystoenterostomy with single-step placement of a 7F double-pigtail plastic stent may be a feasible and useful alternative in patients with acute cholecystitis who are unsuitable candidates for cholecystectomy. 2010 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.
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
Authors: Michel Kahaleh; Everson L A Artifon; Manuel Perez-Miranda; Monica Gaidhane; Carlos Rondon; Takao Itoi; Marc Giovannini Journal: World J Gastroenterol Date: 2015-01-21 Impact factor: 5.742