Endoscopic ultrasound-guided gallbladder drainage for acute cholecystitis: Long-term outcomes after removal of a self-expandable metal stent.

Abstract

AIM:

To assess the long-term outcomes of this procedure after removal of self-expandable metal stent (SEMS). The efficacy and safety of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) with SEMS were also assessed.

METHODS:

Between January 2010 and April 2015, 12 patients with acute calculous cholecystitis, who were deemed unsuitable for cholecystectomy, underwent EUS-GBD with a SEMS. EUS-GBD was performed under the guidance of EUS and fluoroscopy, by puncturing the gallbladder with a needle, inserting a guidewire, dilating the puncture hole, and placing a SEMS. The SEMS was removed and/or replaced with a 7-Fr plastic pigtail stent after cholecystitis improved. The technical and clinical success rates, adverse event rate, and recurrence rate were all measured.

RESULTS:

The rates of technical success, clinical success, and adverse events were 100%, 100%, and 0%, respectively. After cholecystitis improved, the SEMS was removed without replacement in eight patients, whereas it was replaced with a 7-Fr pigtail stent in four patients. Recurrence was seen in one patient (8.3%) who did not receive a replacement pigtail stent. The median follow-up period after EUS-GBD was 304 d (78-1492).

CONCLUSION:

EUS-GBD with a SEMS is a possible alternative treatment for acute cholecystitis. Long-term outcomes after removal of the SEMS were excellent. Removal of the SEMS at 4-wk after SEMS placement and improvement of symptoms might avoid migration of the stent and recurrence of cholecystitis due to food impaction.

• Authors: Ken Kamata, Mamoru Takenaka, Masayuki Kitano, Shunsuke Omoto, Takeshi Miyata, Kosuke Minaga, Kentaro Yamao, Hajime Imai, Toshiharu Sakurai, Tomohiro Watanabe, Naoshi Nishida, Masatoshi Kudo
• Journal: World journal of gastroenterology (World J Gastroenterol) Vol. 23 Issue 4 Pg. 661-667 (Jan 28 2017) ISSN: 2219-2840 [Electronic] United States
• PMID: 28216973 (Publication Type: Journal Article)

Chemical References

• Metals

Topics

• Aged
• Cholecystitis, Acute (surgery)
• Drainage
• Endoscopy
• Endosonography
• Female
• Fluoroscopy
• Gallbladder (diagnostic imaging, surgery)
• Humans
• Male
• Metals
• Middle Aged
• Needles
• Patient Safety
• Reproducibility of Results
• Retrospective Studies
• Stents
• Surgery, Computer-Assisted
• Treatment Outcome