EUS-guided cholecystoenterostomy with single-step placement of a 7F double-pigtail plastic stent in patients who are unsuitable for cholecystectomy: a pilot study (with video) - 22/08/11
Reprint requests: Do Hyun Park, MD, PhD, Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap-2 Dong, Songpa-gu, Seoul 138-736, South Korea.Seoul, South Korea
Abstract |
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.
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| DISCLOSURE: All authors disclosed no financial relationships relevant to this publication. |
Vol 71 - N° 3
P. 634-640 - marzo 2010 Ritorno al numero
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