1
|
Boregowda U, Chen M, Saligram S. Endoscopic Ultrasound-Guided Gallbladder Drainage versus Percutaneous Gallbladder Drainage for Acute Cholecystitis: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2023; 13. [PMID: 36832143 DOI: 10.3390/diagnostics13040657] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/01/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023] Open
Abstract
Background: Percutaneous transhepatic gallbladder drainage (PT-GBD) has been the treatment of choice for acute cholecystitis patients who are not suitable for surgery. The effectiveness of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) as an alternative to PT-GBD is not clear. In this meta-analysis, we have compared their efficacy and adverse events. Methods: We adhered to the PRISMA statement to conduct this meta-analysis. Online databases were searched for studies that compared EUS-GBD and PT-GBD for acute cholecystitis. The primary outcomes of interest were technical success, clinical success, and adverse events. The pooled odds ratio (OR) with a 95% confidence interval (CI) was calculated using the random-effects model. Results: A total of 396 articles were screened, and 11 eligible studies were identified. There were 1136 patients, of which 57.5% were male, 477 (mean age 73.33 ± 11.28 years) underwent EUS-GBD, and 698 (mean age 73.77 ± 8.7 years) underwent PT-GBD. EUS-GBD had significantly better technical success (OR 0.40; 95% CI 0.17-0.94; p = 0.04), fewer adverse events (OR 0.35; 95% CI 0.21-0.61; p = 0.00), and lower reintervention rates (OR 0.18; 95% CI 0.05-0.57; p = 0.00) than PT-GBD. No difference in clinical success (OR 1.34; 95% CI 0.65-2.79; p = 0.42), readmission rate (OR 0.34; 95% CI 0.08-1.54; p = 0.16), or mortality rate (OR 0.73; 95% CI 0.30-1.80; p = 0.50) was noted. There was low heterogeneity (I2 = 0) among the studies. Egger's test showed no significant publication bias (p = 0.595). Conclusion: EUS-GBD can be a safe and effective alternative to PT-GBD for treating acute cholecystitis in non-surgical patients and has fewer adverse events and a lower reintervention rate than PT-GBD.
Collapse
|
2
|
Hemerly MC, de Moura DTH, do Monte Junior ES, Proença IM, Ribeiro IB, Yvamoto EY, Ribas PHBV, Sánchez-luna SA, Bernardo WM, de Moura EGH. Endoscopic ultrasound (EUS)-guided cholecystostomy versus percutaneous cholecystostomy (PTC) in the management of acute cholecystitis in patients unfit for surgery: a systematic review and meta-analysis. Surg Endosc 2022. [PMID: 36289089 DOI: 10.1007/s00464-022-09712-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 10/11/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND AND AIM Surgical cholecystectomy is the gold standard strategy for the management of acute cholecystitis (AC). However, some patients are considered unfit for surgery due to certain comorbid conditions. As such, we aimed to compare less invasive treatment strategies such as endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) and percutaneous gallbladder drainage (PT-GBD) for the management of patients with AC who are suboptimal candidates for surgical cholecystectomy. METHODS A comprehensive search of multiple electronic databases was performed to identify all the studies comparing EUS-GBD versus PT-GBD for patients with AC who were unfit for surgery. A subgroup analysis was also performed for comparison of the group undergoing drainage via cautery-enhanced lumen-apposing metal stents (LAMS) versus PT-GBD. The outcomes included technical and clinical success, adverse events (AEs), recurrent cholecystitis, reintervention, and hospital readmission. RESULTS Eleven studies including 1155 patients were included in the statistical analysis. There was no difference between PT-GBD and EUS-GBD in all the evaluated outcomes. On the subgroup analysis, the endoscopic approach with cautery-enhanced LAMS was associated with lower rates of adverse events (RD = - 0.33 (95% CI - 0.52 to - 0.14; p = 0.0006), recurrent cholecystitis (- 0.05 RD (95% CI - 0.09 to - 0.02; p = 0.02), and hospital readmission (- 0.36 RD (95% CI-0.70 to - 0.03; p = 0.03) when compared to PT-GBD. All other outcomes were similar in the subgroup analyses. CONCLUSIONS EUS-GBD using cautery-enhanced LAMS is superior to PT-GBD in terms of safety profile, recurrent cholecystitis, and hospital readmission rates in the management of patients with acute cholecystitis who are suboptimal candidates for cholecystectomy. However, when cautery-enhanced LAMS are not used, the outcomes of EUS-GBD and PT-GBD are similar. Thus, EUS-GBD with cautery-enhanced LAMS should be considered the preferable approach for gallbladder drainage for this challenging population.
Collapse
|
3
|
Di Cocco BL, Westerveld DR, Hajifathalian K, Mahadev S, Sharaiha RZ, Sampath K. Successful minimally invasive management of adverse events following EUS-guided gallbladder drainage in a suboptimal surgical patient. VideoGIE 2022; 7:361-363. [PMID: 36238806 PMCID: PMC9551617 DOI: 10.1016/j.vgie.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Bianca L Di Cocco
- Division of Internal Medicine, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Donevan R Westerveld
- Division of Gastroenterology and Hepatology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Kaveh Hajifathalian
- Division of Gastroenterology and Hepatology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - SriHari Mahadev
- Division of Gastroenterology and Hepatology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Reem Z Sharaiha
- Division of Gastroenterology and Hepatology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Kartik Sampath
- Division of Gastroenterology and Hepatology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| |
Collapse
|
4
|
Zachäus M, Bartels M, Flade A, Schubert-Hartmann A, Lamberts R, Sepehri-Shamloo A, Halm UP. [Endoscopic Ultrasound Drainage of the Gallbladder in Acute Cholecystitis in Patients at High Surgical Risk]. Zentralbl Chir 2021; 148:140-146. [PMID: 34763360 DOI: 10.1055/a-1657-0197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The standard treatment for acute cholecystitis is laparoscopic cholecystectomy. Alternative procedures are used for patients at high surgical risk. Percutaneous drainage is widely available. The alternative of transpapillary drainage of the gallbladder via the ductus cysticus has only limited prospects of success. With the widespread use of interventional endoscopic ultrasound and the development of new stent systems, endoscopic ultrasound gallbladder drainage has proven to be a safe and reliable procedure. MATERIAL AND METHOD We retrospectively report on our experiences in 11 consecutive patients with endoscopic ultrasound gallbladder drainage in acute cholecystitis between December 2018 and January 2021. RESULTS 11 patients with acute cholecystitis with a mean age of 84.5 years (70-95 years) are reported. All patients had severe general comorbidities or advanced abdominal tumours or a combination of these conditions. After interdisciplinary debate, the indication for interventional therapy was made. This was carried out in 9 cases by means of endosonographic drainage alone and in 2 cases by means of percutaneous and two-stage endosonographic drainage. Technical success was achieved in 10 cases (91%), clinical success in 9 cases (82%). In 2 cases there were procedural complications that led to the operation. CONCLUSION In the case of high surgical risks, endosonographic drainage of the gall bladder is a safe and definitive therapy. This can be performed alone or in combination with percutaneous drainage. Endoscopic ultrasound drainage is superior to percutaneous drainage alone, due to its lower complication rates and lower rates of necessary follow-up interventions. Therefore, in cases of relatively high surgical risk, endoscopic ultrasound drainage of the gall bladder should be preferred to percutaneous drainage, especially when definitive therapy is required.
Collapse
Affiliation(s)
- Markus Zachäus
- Klinik für Gastroenterologie, Hepatologie, Hämatologie, Onkologie, Palliativmedizin, HELIOS Park-Klinikum Leipzig, Leipzig, Deutschland
| | - Michael Bartels
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, HELIOS Park-Klinikum Leipzig, Leipzig, Deutschland
| | - Andreas Flade
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, HELIOS Park-Klinikum Leipzig, Leipzig, Deutschland
| | - Andreas Schubert-Hartmann
- Klinik für Gastroenterologie, Hepatologie, Hämatologie, Onkologie, Palliativmedizin, HELIOS Park-Klinikum Leipzig, Leipzig, Deutschland
| | - Regina Lamberts
- Klinik für Gastroenterologie, Hepatologie, Hämatologie, Onkologie, Palliativmedizin, HELIOS Park-Klinikum Leipzig, Leipzig, Deutschland
| | | | - Ulrich Paul Halm
- Klinik für Gastroenterologie, Hepatologie, Hämatologie, Onkologie, Palliativmedizin, HELIOS Park-Klinikum Leipzig, Leipzig, Deutschland
| |
Collapse
|
5
|
McCarty TR, Hathorn KE, Bazarbashi AN, Jajoo K, Ryou M, Thompson CC. Endoscopic gallbladder drainage for symptomatic gallbladder disease: a cumulative systematic review meta-analysis. Surg Endosc 2021; 35:4964-4985. [PMID: 34231061 DOI: 10.1007/s00464-020-07758-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 06/23/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Endoscopic ultrasound (EUS)-guided transmural or endoscopic retrograde cholangiography (ERC)-based transpapillary drainage may provide alternative treatment strategies for high-risk surgical candidates with symptomatic gallbladder (GB) disease. The primary aim of this study was to perform a systematic review and meta-analysis to investigate the efficacy and safety of endoscopic GB drainage for patients with symptomatic GB disease. METHODS Searches of PubMed, EMBASE, Web of Science, and Cochrane Library databases were performed in accordance with PRISMA and MOOSE guidelines. Pooled proportions were calculated for measured outcomes including technical success, clinical success, adverse event rate, recurrence rate, and rate of reintervention. Subgroup analyses were performed for transmural versus transpapillary, transmural lumen apposing stent (LAMS), and comparison to percutaneous transhepatic drainage. Heterogeneity was assessed with I2 statistics. Publication bias was ascertained by funnel plot and Egger regression testing. RESULTS Thirty-six studies (n = 1538) were included. Overall, endoscopic GB drainage achieved a technical and clinical success of 87.33% [(95% CI 84.42-89.77); I2 = 39.55] and 84.16% [(95% CI 80.30-87.38); I2 = 52.61], with an adverse event rate of 11.00% [(95% CI 9.25-13.03); I2 = 7.08]. On subgroup analyses, EUS-guided transmural compared to ERC-assisted transpapillary drainage resulted in higher technical and clinical success rates [OR 3.91 (95% CI 1.52-10.09); P = 0.005 and OR 4.59 (95% CI 1.84-11.46); P = 0.001] and lower recurrence rate [OR 0.17 (95% CI 0.06-0.52); P = 0.002]. Among EUS-guided LAMS studies, technical success was 94.65% [(95% CI 91.54-96.67); I2 = 0.00], clinical success was 92.06% [(95% CI 88.65-94.51); I2 = 0.00], and adverse event rate was 11.71% [(95% CI 8.92-15.23); I2 = 0.00]. Compared to percutaneous drainage, EUS-guided drainage possessed a similar efficacy and safety with significantly lower rate of reintervention [OR 0.05 (95% CI 0.02-0.13); P < 0.001]. DISCUSSION Endoscopic GB drainage is a safe and effective treatment for high-risk surgical candidates with symptomatic GB disease. EUS-guided transmural drainage is superior to transpapillary drainage and associated with a lower rate of reintervention compared to percutaneous transhepatic drainage.
Collapse
Affiliation(s)
- Thomas R McCarty
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, 02115, USA
| | - Kelly E Hathorn
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, 02115, USA
| | - Ahmad Najdat Bazarbashi
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, 02115, USA
| | - Kunal Jajoo
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, 02115, USA
| | - Marvin Ryou
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, 02115, USA
| | - Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA. .,Harvard Medical School, Boston, MA, 02115, USA.
| |
Collapse
|
6
|
Abstract
Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has emerged as a safe and effective minimally invasive alternative to both percutaneous and endoscopic transpapillary GBD in patients with acute cholecystitis. Over the last few years, the technique, as well as the indications for EUS-GBD have been gradually evolving, and the procedure has become simpler and safer as the accepted indications have expanded. The development of lumen-apposing metal stents (LAMS) has allowed us to realize the dream of creating endoscopic gastrointestinal anastomoses, and has thus paved the way for a safer EUS-GBD. Single step EUS-guided LAMS delivery systems have obviated the use of other endoscopic accessories and thus made EUS-GBD simpler and safer. However, EUS-GBD can be associated with potentially serious complications, and therefore should be performed by expert interventional endosonologists at centers with surgical and radiological back up. EUS-GBD is a relatively new procedure still in its infancy, but continued improvement in EUS accessories and dedicated stents will make this procedure safer and also expand its current indications. This review focuses on the technical aspects, including procedural details, as well as the complications of EUS-GBD.
Collapse
Affiliation(s)
- Surinder S Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| |
Collapse
|
7
|
Shariatmadari I, Rossi C, Krishna K. Mistaken identity: an unexpected case of spontaneous cholecystocutaneous fistula formation. BMJ Case Rep 2021; 14:14/2/e234191. [PMID: 33547115 PMCID: PMC7871220 DOI: 10.1136/bcr-2019-234191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We describe the case of a 78-year-old woman who presented to the emergency department with a 2-week history of a superficially developing mass in the lower right abdominal wall, fluctuant and non-tender with overlaying erythematous skin changes. Though resembling an abdominal wall abscess and initially listed for a simple incision and drainage, diagnostic uncertainty encouraged further investigation. CT and ultrasound confirmed the mass appeared to be in continuity with the gallbladder fossa, with the lumen also containing small bowel medially. While awaiting a multidisciplinary team discussion, the patient re-presented with concern over discharge appearing at the site of the mass. On inspection, we noted black flecks and small stones. This case describes the unusual and rare presentation of a cholecystocutaneous fistula. The patient was managed conservatively and remains clinically well.
Collapse
Affiliation(s)
- Isla Shariatmadari
- General Surgery, Weston General Hospital, Weston-super-Mare, North Somerset, UK
| | - Chiara Rossi
- General Surgery, Weston General Hospital, Weston-super-Mare, North Somerset, UK
| | - Kandaswamy Krishna
- General Surgery, Weston General Hospital, Weston-super-Mare, North Somerset, UK
| |
Collapse
|
8
|
Fagenson AM, Powers BD, Zorbas KA, Karhadkar S, Karachristos A, Di Carlo A, Lau KN. Frailty Predicts Morbidity and Mortality After Laparoscopic Cholecystectomy for Acute Cholecystitis: An ACS-NSQIP Cohort Analysis. J Gastrointest Surg 2021; 25:932-40. [PMID: 32212087 DOI: 10.1007/s11605-020-04570-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 03/03/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Current guidelines recommend laparoscopic cholecystectomy be offered for patients with acute cholecystitis except those deemed as high risk. Few studies have examined the impact of frailty on outcomes for patients undergoing laparoscopic cholecystectomy. Therefore, the aim of this study was to determine the association of frailty with postoperative morbidity and mortality in patients undergoing laparoscopic cholecystectomy for acute cholecystitis. METHODS Patients undergoing laparoscopic cholecystectomy for acute cholecystectomy were identified from 2005 to 2010 in the American College of Surgeons National Surgical Quality Improvement Project (NSQIP). The Modified Frailty Index (mFI) was used a surrogate for frailty, and patients were stratified as non-frail (mFI 0), low frailty (mFI 1-2), intermediate frailty (mFI 3-4) and high frailty (mFI ≥ 5). Univariable and multivariable analyses were performed. Receiver operator curves (ROC) and an area under the curve (AUC) were generated to determine accuracy of mFI in predicting postoperative morbidity and mortality. RESULTS Of the 6898 patients undergoing laparoscopic cholecystectomy, 3245 (47%) patients were non-frail. There were 2913 (42%) patients with low-frailty, 649 (9%) patients with intermediate frailty, and 91 (2%) with high frailty. Clavien IV complications were higher for intermediate frail patients (OR 1.81, 95% CI 1.00-3.28, p = 0.050) and high-frail patients (OR 4.59, 95% CI 1.98-10.7, p < 0.001). Additionally, mortality was higher for patients with intermediate frailty (OR 4.69, 95% CI 1.37-16.0, p = 0.014) and high frailty (OR 12.2, 95% CI 2.67-55.5, p = 0.001). The mFI had excellent accuracy for mortality (AUC = 0.83) and Clavien IV complications (AUC = 0.73). CONCLUSION Frailty is associated with postoperative morbidity and mortality in patients undergoing laparoscopic cholecystectomy for acute cholecystitis.
Collapse
|
9
|
|
10
|
Umapathy C, Gajendran M, Mann R, Boregowda U, Theethira T, Elhanafi S, Perisetti A, Goyal H, Saligram S. Pancreatic fluid collections: Clinical manifestations, diagnostic evaluation and management. Dis Mon 2020; 66:100986. [PMID: 32312558 DOI: 10.1016/j.disamonth.2020.100986] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Pancreatic fluid collections (PFC), including pancreatic pseudocysts and walled-off pancreatic necrosis, are a known complication of severe acute pancreatitis. A majority of the PFCs remain asymptomatic and resolve spontaneously. However, some PFCs persist and can become symptomatic. Persistent PFCs can also cause further complications such as the gastric outlet, intestinal, or biliary obstruction and infection. Surgical interventions are indicated for the drainage of symptomatic sterile and infected PFCs. Management of PFCs has evolved from a primarily surgical or percutaneous approach to a less invasive endoscopic approach. Endoscopic interventions are associated with improved outcomes with lesser chances of complications, faster recovery time, and lower healthcare utilization. Endoscopic ultrasound-guided drainage of PFCs using lumen-apposing metal stents has become the preferred approach for the management of symptomatic and complicated PFCs.
Collapse
|
11
|
Corbetta Machado MJ, Gray A, Cerdeira MP, Gani J. Short- and long-term outcomes of percutaneous cholecystostomy in an Australian population. ANZ J Surg 2020; 90:1660-1665. [PMID: 32080967 DOI: 10.1111/ans.15726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/13/2019] [Accepted: 01/13/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Percutaneous cholecystostomy (PC) is a well-recognized management option for the treatment of acute cholecystitis (AC) in high-risk patients. Patient characteristics, efficacy and particularly the longer-term outcomes for patients having PC across the Hunter New England Local Health District were analysed. METHODS A retrospective audit from January 2013 to September 2017 was undertaken. Patients were followed up until September 2019. All were retrospectively risk assessed using the P-POSSUM risk assessment tool, complications and mortality were recorded. In addition to short-term data, longer-term outcomes including patient's living situation at 6 and 12 months were analysed. RESULTS A total of 82 patients were assessed at ≥12 months post procedure or until death. Successful initial gallbladder drainage was achieved in 99% of cases. The mean P-POSSUM score for mortality was 11%, confirming that this is a high-risk group; 17% had inpatient complications recorded; 10% of these were major (Clavien-Dindo ≥III). Outpatient complications were seen in 45%, 59% underwent further biliary tree intervention and 24% had recurrent AC. Thirty-day mortality was 12% and 1-year mortality was 22%. Functional capacity changed significantly for 41% of patients at 1 year, with 12% requiring a new admission to high-level nursing home care. CONCLUSION Our series represents the largest reported Australasian series of PC for AC published to date. It confirms that PC is well-established and safe in high-risk patients. However, further intervention rates and recurrence rates of AC are high and escalation of dependency of care affects almost half of patients.
Collapse
Affiliation(s)
| | - Andrew Gray
- Division of Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia.,Department of Medicine, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Marisol P Cerdeira
- Division of Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia.,Department of Medicine, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Jon Gani
- Division of Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia.,Department of Medicine, The University of Newcastle, Newcastle, New South Wales, Australia
| |
Collapse
|
12
|
Rahman S, Krokidis M, Paraskevopoulos I. Transcholecystic approach for distal common bile duct stricture in a non-dilated biliary system: an alternative route. BMJ Case Rep 2019; 12:12/12/e231153. [PMID: 31888920 DOI: 10.1136/bcr-2019-231153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 63-year-old patient was admitted to intensive treatment unit with biliary sepsis due to a small distal common bile duct stone. Endoscopic retrograde cholangiopancreatography was initially attempted for insertion of a biliary stent but failed due to the presence of a periampullary diverticulum. Referral to interventional radiology for percutaneous drainage was considered the next alternative even though there was no dilatation of intrahepatic ducts. Due to complete absence of intrahepatic duct dilatation, the traditional percutaneous transhepatic route was considered rather challenging. An alternative percutaneous approach via the gallbladder and subsequent catheterisation of the duodenum via the distal common bile duct was successfully performed instead without complication. We would like to describe this technique as an alternative option for drainage of the non-dilated biliary system in patients with sepsis.
Collapse
Affiliation(s)
- Syed Rahman
- Clinical Radiology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Miltiadis Krokidis
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | |
Collapse
|
13
|
Harima H, Sanuki K, Sakaida I. Successful endoscopic ultrasound-guided gallbladder drainage through the mesh of a duodenal stent for cholecystitis in a patient with pancreatic cancer. Dig Endosc 2019; 31:e86-e87. [PMID: 31025762 DOI: 10.1111/den.13409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 03/25/2019] [Indexed: 02/08/2023]
Affiliation(s)
- Hirofumi Harima
- Department of Gastroenterology, Ube Industries Central Hospital, Yamaguchi, Japan
| | - Kazutoshi Sanuki
- Department of Gastroenterology, Ube Industries Central Hospital, Yamaguchi, Japan
| | - Isao Sakaida
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| |
Collapse
|