Clin Endosc.  2024 Mar;57(2):263-267. 10.5946/ce.2022.213.

Single-pigtail plastic stent made from endoscopic nasobiliary drainage tubes in endoscopic ultrasound-guided gallbladder drainage: a retrospective case series

• Soga K

• KMID: 2553764
• DOI: http://doi.org/10.5946/ce.2022.213

Abstract

Technical failure of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is often attributed to device failure. To rectify this problem, we developed a single-pigtail plastic stent (SPPS) for EUS-GBD. We retrospectively reviewed the cases of four patients who underwent EUS-GBD for acute cholecystitis. To prepare the SPPS, a 7.5-Fr endoscopic nasobiliary drainage tube was cut to an appropriate length. The use of SPPS during EUS-GBD was successful from both technical and clinical standpoints. The SPPS spontaneously detached 57 days after the procedure in patient 4 and 412 days after the procedure in patient 1. Patient 1 developed cholecystitis after 426 days and was managed with antibiotics. The other three patients did not develop any complications after surgery. In conclusion, we designed a new SPPS dedicated to EUS-GBD and established its technical feasibility and clinical effectiveness.

Keyword

Cholecystitis; Endoscopic ultrasound; Gallbladder drainage; Percutaneous cholecystostomy

Figure

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  Fig. 1. Concept of the single-pigtail plastic stent (SPPS). The SPPS was improvised from a commercial 7.5-Fr endoscopic nasobiliary drainage (ENBD) tube (A, Flexima; Boston Scientific), and side holes were added via a percutaneous transhepatic biliary drainage tube punch (B). The ENBD tube was shortened to 15 to 20 cm from the straight section (C). When the SPPS is constructed from ENBD tubes, it has a narrower tip at the end that widens when compared to the double-pigtail plastic stent, which improves insertion by reducing the possibility of the tube getting stuck in the intestinal lumen (D).

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  Fig. 2. Endoscopic ultrasound (EUS)-guided gallbladder drainage procedure with single-pigtail plastic stent (SPPS). The gallbladder was punctured from the duodenal bulb using a 19-G fine-needle with EUS in the pushing scope position (A). Puncture of the gallbladder was confirmed with contrast injection using fluoroscopy (B). After completion of EUS, a 6-Fr pigtail endoscopic nasobiliary drainage tube was temporarily inserted together with the SPPS (C). We confirmed the condition of the EUS-guided gallbladder drainage tube with SPPS by using contrast imaging from the endoscopic nasobiliary drainage tube before removing the supportive tube (D). Contrast imaging confirmed a complete fistula at the puncture site (D, arrow) and contrast medium flowing from the SPPS fragment (D, arrowhead).

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  Fig. 3. Schematic of a plastic stent caught on the edge of the puncture site during the endoscopic ultrasound-guided gallbladder drainage procedure. Although the inner sheath was inserted into the gallbladder, the gap between the inner sheath and the double-pigtail plastic stent (DPPS) (A) was caught on the edge of the intestinal wall, and the DPPS could not be inserted into the gallbladder (B). Single-pigtail plastic stents (SPPS) made from endoscopic nasobiliary drainage tubes are narrower at the tip than DPPS, which improves insertion by limiting the chance of the tube getting stuck in the intestinal lumen (C). The tip shape facilitates SPPS insertion because the smaller difference in diameter between the guidewire and SPPS with a narrower tip, as compared with the DPPS, improves the ease with which the catheter can be advanced through the duodenal wall (D).

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