Jennifer T Higa1, Shayan S Irani2. 1. Division of Gastroenterology and Hepatology, Fox Chase Cancer Center, 333 Cottman Avenue, P3179, Philadelphia, PA, 19111, USA. 2. Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, 1100 Ninth Avenue, Mailstop: C3-GAS, Seattle, WA, 98101, USA. shayan.irani@virginiamason.org.
Abstract
PURPOSE OF REVIEW: Acute cholecystitis is conventionally managed with cholecystectomy; however, when this occurs in the non-operative patient, it requires consideration for alternative means of gallbladder drainage (GBD). RECENT FINDINGS: Suitable endoscopic methods for GBD include transpapillary cystic duct stent or endoscopic ultrasound (EUS)-guided transmural stent placement. Importantly, patients who undergo endoscopic GBD have comparable outcomes to those who undergo placement of percutaneous transhepatic catheters by interventional radiology (IR). There is evolving evidence to support endoscopic gallbladder drainage by EUS or ERCP with transpapillary stenting for patients who are non-operative candidates. There appear to be advantages over percutaneous drainage in terms of lower rates of recurrent cholecystitis, faster clinical resolution of symptoms, and omission of external drain-related complications. However, careful consideration of individual characteristics is warranted in the care of these complicated patients. The technical and clinical considerations for endoscopic methods of GB drainage are discussed in this review article.
PURPOSE OF REVIEW: Acute cholecystitis is conventionally managed with cholecystectomy; however, when this occurs in the non-operative patient, it requires consideration for alternative means of gallbladder drainage (GBD). RECENT FINDINGS: Suitable endoscopic methods for GBD include transpapillary cystic duct stent or endoscopic ultrasound (EUS)-guided transmural stent placement. Importantly, patients who undergo endoscopic GBD have comparable outcomes to those who undergo placement of percutaneous transhepatic catheters by interventional radiology (IR). There is evolving evidence to support endoscopic gallbladder drainage by EUS or ERCP with transpapillary stenting for patients who are non-operative candidates. There appear to be advantages over percutaneous drainage in terms of lower rates of recurrent cholecystitis, faster clinical resolution of symptoms, and omission of external drain-related complications. However, careful consideration of individual characteristics is warranted in the care of these complicated patients. The technical and clinical considerations for endoscopic methods of GB drainage are discussed in this review article.