Clin Endosc.  2023 Sep;56(5):650-657. 10.5946/ce.2022.190.

Clinical outcomes of permanent stenting with endoscopic ultrasound gallbladder drainage

• Suzuki E
• Fujita Y
• Hosono K
• Koyama Y
• Tsujino S
• Teratani T
• Nakajima A
• Matsuhashi N

• KMID: 2546143
• DOI: http://doi.org/10.5946/ce.2022.190

Abstract

Background/Aims
Endoscopic ultrasound gallbladder drainage (EUS-GBD) is gaining attention as a treatment method for cholecystitis. However, only a few studies have assessed the outcomes of permanent stenting with EUS-GBD. Therefore, we evaluated the clinical outcomes of permanent stenting using EUS-GBD.
Methods
This was a retrospective, single-center cohort study. The criteria for EUS-GBD at our institution are a high risk for surgery, inability to perform surgery owing to poor performance status, and inability to obtain consent for emergency surgery. EUS-GBD was performed using a 7-Fr double-pigtail plastic stent with a dilating device. The primary outcomes were the recurrence-free rate of cholecystitis and the late-stage complication-avoidance rate. Secondary outcomes were technical success, clinical success, and procedural adverse events.
Results
A total of 41 patients were included in the analysis. The median follow-up period was 168 (range, 10–1,238) days. The recurrence-free and late-stage complication-avoidance rates during the follow-up period were 95% (38 cases) and 90% (36 cases), respectively. There were only two cases of cholecystitis recurrence during the study period.
Conclusions
EUS-GBD using double-pigtail plastic stent was safe and effective with few complications, even in the long term, in patients with acute cholecystitis.

Keyword

Cholecystitis; Cystic duct, Drainage; Endosonography; Stents

Figure

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  Fig. 1. Among the 73 patients with cholecystitis, 32 patients undergoing BTS were excluded, and 41 patients who met the indication criteria and provided consent underwent permanent stenting. BTS, bridge-to-surgery.

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  Fig. 2. . Endoscopic ultrasound gallbladder drainage procedure images. (A) Endoscopic ultrasound image during gallbladder puncture. (B) Fluoroscopic image of a balloon catheter being dilated. (C) Fluoroscopic image of plastic stent implantation. (D) Endoscopic image of plastic stent implantation.

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  Fig. 3. The horizontal axis presents the number of follow-up days, and the vertical axes present (A) the non-occurrence rate of cholecystitis and (B) the late-stage complication-avoidance rate.

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  Fig. 4. The fistula between the gallbladder (GB) and the duodenum (DU) is shown by the arrow in the laparoscopic cholecystectomy.

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