Korean J Gastroenterol.  2018 Aug;72(2):83-85. 10.4166/kjg.2018.72.2.83.

A Guidewire May Save the Day

• Garg R
• Barawi M

• KMID: 2418768
• DOI: http://doi.org/10.4166/kjg.2018.72.2.83

Abstract

Endoscopic gallbladder drainage (EGBD) has been used to treat acute cholecystitis or to relieve malignant biliary obstruction as an alternative to percutaneous gallbladder drainage and patient's are poor surgical candidates. This is currently being performed by placement of lumen apposing metallic stent (LAMS) with electrocautery mounted tip delivery system also called as "hot" technique. We had reported a case of self-expanding metallic stent (SEMS) within LAMS after stent migration during EGBD using "hot" technique and propose routine use of guidewire in patients undergoing the procedure.

Keyword

Ultrasound; Endoscopy; Stent; Cholelithiasis

MeSH Terms

Cholecystitis, Acute
Cholelithiasis
Drainage
Electrocoagulation
Endoscopy
Gallbladder
Humans
Stents
Ultrasonography

Figure

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  Fig. 1 Linear EUS image showing distended gallbladder abutting the gastric wall. EUS, endoscopic ultrasound.

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  Fig. 2 Dark copious bile flowing through LAMS. Note that distal flange is not visible and is retracted into gastric wall. LAMS, lumen apposing metallic stent.

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  Fig. 3 A 0.035 inch jag guidewire being passed through the LAMS. LAMS, lumen apposing metallic stent.

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  Fig. 4 Fluoroscopic image showing coiled guidewire in the gallbladder lumen with deployment of both stents (A). Distal flange of SEMS seen in gastric lumen after successful placement (B). SEMS, self-expanding metallic stents.

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