Michael Kostrzewa1,2, Rebecca Zener3, Lee L Swanström4,5, Eran Shlomovitz3,4. 1. Division of Vascular and Interventional Radiology, Toronto General Hospital, University Health Network/University of Toronto, 585 University Avenue, Toronto, ON, M5G2N2, Canada. mk@mikos.me. 2. Institute of Image Guided Surgery (IHU), 1 Place de l'Hôpital, 67000, Strasbourg, France. mk@mikos.me. 3. Division of Vascular and Interventional Radiology, Toronto General Hospital, University Health Network/University of Toronto, 585 University Avenue, Toronto, ON, M5G2N2, Canada. 4. Institute of Image Guided Surgery (IHU), 1 Place de l'Hôpital, 67000, Strasbourg, France. 5. Gastrointestinal & Minimally Invasive Surgery, The Oregon Clinic, 4805 NE Glisan Street Suite 6N60, Portland, OR, 97213, USA.
Abstract
BACKGROUND: Cholecystostomy is commonly performed in high-risk patients with acute cholecystitis. However, internal drainage may be more desirable in patients as it is associated with lower complication rates. This paper describes an image-guided, percutaneous technique for internal gallbladder drainage using a covered lumen-apposing metal stent (LAMS) and assesses its feasibility and safety in a porcine model. METHODS: Procedures were performed on 30-kg pigs. Under ultrasound and fluoroscopic guidance, a percutaneous puncture was performed through-and-through the gallbladder into the stomach. A guidewire was placed and a 12Fr sheath was advanced through which a 10-mm LAMS was deployed. Its distal flange was deployed in the gastric lumen, and its proximal flange in the gallbladder. The cholecystoenteric anastomosis was examined by means of endoscopy, laparoscopy, and necropsy. RESULTS: Technical success was 100% (7/7). Procedure times decreased with experience and improvements in technique (median: 22 min). Contrast injection demonstrated free flow through the stent with no leakage. Necropsy confirmed appropriate stent position with good apposition of gallbladder and stomach, and no intraprocedural complications were detected. CONCLUSIONS: Image-guided, percutaneous, internal gallbladder drainage using a LAMS is safe and feasible in a porcine model. This technique may be an alternative to endoscopic ultrasound-guided stent placement and external cholecystostomy tube drainage.
BACKGROUND: Cholecystostomy is commonly performed in high-risk patients with acute cholecystitis. However, internal drainage may be more desirable in patients as it is associated with lower complication rates. This paper describes an image-guided, percutaneous technique for internal gallbladder drainage using a covered lumen-apposing metal stent (LAMS) and assesses its feasibility and safety in a porcine model. METHODS: Procedures were performed on 30-kg pigs. Under ultrasound and fluoroscopic guidance, a percutaneous puncture was performed through-and-through the gallbladder into the stomach. A guidewire was placed and a 12Fr sheath was advanced through which a 10-mm LAMS was deployed. Its distal flange was deployed in the gastric lumen, and its proximal flange in the gallbladder. The cholecystoenteric anastomosis was examined by means of endoscopy, laparoscopy, and necropsy. RESULTS: Technical success was 100% (7/7). Procedure times decreased with experience and improvements in technique (median: 22 min). Contrast injection demonstrated free flow through the stent with no leakage. Necropsy confirmed appropriate stent position with good apposition of gallbladder and stomach, and no intraprocedural complications were detected. CONCLUSIONS: Image-guided, percutaneous, internal gallbladder drainage using a LAMS is safe and feasible in a porcine model. This technique may be an alternative to endoscopic ultrasound-guided stent placement and external cholecystostomy tube drainage.