Rebecca Zener, MD1, Lee Swanstrom, MD2, Eran Shlomovitz, MD3. 1University of Toronto Joint Department of Medical Imaging, 22. Institute of Image Guided Surgery, Strasbourg, France, 3University of Toronto Joint Department of Medical Imaging and Department of Surgery
INTRODUCTION: Lumen-apposing self-expandable cholecysto-enteric stents (LOSES) are increasingly placed as an alternative to cholecystectomy in high risk patients. The purpose of this study was to assess the prevalence of patients whose anatomy would allow either percutaneous or endoscopic ultrasound (EUS) guided stent insertion from a population of patients with acute cholecystitis.
METHODS AND PROCEDURES: Contrast enhanced axial and coronal abdominal CT images in 100 consecutive patients with a diagnosis of acute cholecystitis were retrospectively reviewed. A determination of the feasibility of placing a LOSES via a percutaneous puncture or endoscopically with EUS guidance was made by the presence of a clear trajectory in any CT plane between the gallbladder and the gastric antrum or proximal duodenum measuring ≤2cm and free of intervening structures.
RESULTS: The gallbladder was within 2 cm of the gastrointestinal (GI) tract without intervening structures in 95 of 100 patients (95%). Percutaneous LOSES was anatomically feasible in 90 of 100 patients (90%), 79 (87.8%) of which were feasible in both axial and coronal CT planes. Of the feasible cases, four (4.4%) were feasible in the coronal plane only. Mean shortest inner-inner wall distance between the gallbladder and the adjacent proximal GI tract was 1.20 ± 0.43 cm. The closest location for LOSES was between the gallbladder and duodenum in 87 of feasible cases (97%). The percutaneous approach was transhepatic in 89.5%, and extrahepatic in 10.5%. EUS guided LOSES appeared feasible in 95 of the 100 patients including 5 of the 10 percutaneously unfeasible cases. The other 5 patients appeared unfeasible endoscopically or percutaneously due to colonic interposition or large gaps of intervening fat.
CONCLUSION: LOSES is anatomically feasible percutaneously or by EUS in 90% and 95% of acute cholecystitis patients, respectively. Percutaneous LOSES may potentially represent an attractive replacement to external cholecystostomy tube drainage or as an alternative option to endoscopic placement.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 77635
Program Number: P084
Presentation Session: Poster (Non CME)
Presentation Type: Poster
