Biliopancreatic Endoscopy by Kwok-Hung Lai Lein-Ray Mo & Hsiu-Po Wang

Author:Kwok-Hung Lai, Lein-Ray Mo & Hsiu-Po Wang
Language: eng
Format: epub
Publisher: Springer Singapore, Singapore

Cholecystoduodenostomy

The gallbladder (GB) drainage is usually done radiologically or under conventional abdominal ultrasound guided, but the advent of interventional EUS has made it possible to drain the GB endoscopically. This may be indicated in those patients with acute cholecystitis who are unsuitable for surgery and who have no improvement with antibiotics. In addition, it may be of value in situation where a percutaneous procedure is difficult or more risky (presence of ascites and coagulopathy). Sometimes, EUS-guided GB drainage has also been used as an approach for drainage in unresectable pancreatic cancer with use of anti-migratory fully covered metallic stents [37]. In a randomized study published from Jang et al., patients with acute cholecystitis were assigned to undergo either an EUS-guided drainage or a percutaneous drainage of gallbladder, both the technical success rates and the complication rates are similar. This result suggests that EUS-guided approach is feasible for gallbladder drainage with outcomes comparable to the percutaneous approach [38]. The complication of gallbladder drainage may include bile leak, perforation, and pneumoperitoneum. In a report evaluating long-term outcomes in 56 patients with acute cholecystitis who had underwent EUS-guided gallbladder drainage, the stent patency was 86% over 3 years [39]. A single step procedure for insertion for lumen-apposing metallic stent using a cautery-tipped stent delivery system has also been reported [40].

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