Efficacy of an easy loop-forming guidewire in endoscopic transpapillary gallbladder drainage with gallstones impacted in the cystic duct.

Abstract

Endoscopic transpapillary gallbladder drainage (ETGBD) is a drainage method for acute cholecystitis; it is often used in patients who are on antithrombotic drugs or in those presenting with ascites [1] [2] [3]. However, the success rate of the procedure is lower than that of percutaneous transhepatic biliary drainage (PTGBD), and one of the reasons for this is the difficulty of inserting the guidewire into the gallbladder [4]. Especially in cases where a stone is impacted in the cystic duct, it becomes even more difficult to insert the guidewire into the gallbladder [5].A 75-year-old man with acute cholecystitis had been referred because of septic shock. The patient was taking two antithrombotic drugs. Computed tomography revealed gallbladder wall thickening, gallstones, and fat-stranding around the enlarged gallbladder ([Fig. 1]). Magnetic resonance cholangiopancreatography confirmed the presence of impacted gallstones in the cystic duct ([Fig. 2]). Because of the antithrombotic drugs and the presence of ascites, ETGBD was selected as the drainage method.