Arun Kritsanasakul, Chotirot Angkurawaranon, Jerasak Wannapraset, Thawee Rattanachu-ek, Kannikar Laohavichitra. Rajavithi Hospital
Background: Surgery is the mainstay of treatment for cholecystitis, however, it may not be safe or feasible in some circumstances such as severe cholecystitis or cholecystitis in extremely high-risk patients. Gallbladder drainage may be an appropriate alternative or a bridging option prior to cholecystectomy. Endoscopic trans-papillary gallbladder drainage (ETGBD) has been proposed as a modality that is feasible and effective in cholecystitis.
Objective: The primary outcome of this study is to evaluate the effectiveness of ETGBD. The secondary outcome is to evaluate the safety, early experience outcomes, and complications of this procedure.
Methods: Retrospective medical records review between January 2014-December 2016 from a single tertiary referral hospital center, Rajavithi Hospital, Bangkok, Thailand. A total of 6 patients who was diagnosed with cholecystitis and underwent ETGBD. The procedure was performed at the endoscopic suite under light sedation via total intravenous anesthesia. The patient demographic data and procedures were collected. The technical success of ETGBD was defined as decompression of the gallbladder by successful cystic duct stent placement. The clinical success was defined as resolution of symptoms and/or improved laboratory data or ultra-sonographic findings.
Results: A total of 6 patients underwent ETGBD. Among these patients, 4 were high risk for surgery due to age or comorbidity, 1 had concomitant jaundice and 1 was failure of medical treatment. Both technical and clinical success of ETGBD was achieved in 4 of 6 cases (67%). The two patients that did not achieve technical success were due to failure to cannulate guidewire through cystic duct and the other had trans-cystic guidewire perforation that needed surgical intervention. There were two intra-operative complications (33%). One was the patient who had trans-cystic guidewire perforation and another had anesthesia-related complication (hypoventilation requiring endotracheal intubation). There were no 30-day mortality.
Conclusion: Endoscopic trans-papillary gallbladder drainage is an alternative treatment modality for patients with cholecystitis who are at high-risk for surgery and or those who are unsuitable for percutaneous gallbladder drainage. The technique is feasible, however, careful case selection and high endoscopic skill is needed.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86556
Program Number: P103
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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