Endoscopic cutting technique using scissors forceps after temporary endoscopic naso‐gallbladder drainage for acute cholecystitis (with videos)

Abstract

Endoscopic naso-gallbladder drainage (ENGBD) is useful in acute cholecystitis patients until surgery [1, 2]. However, cholecystectomy may become difficult during treatment owing to patient illness. Although endoscopic transpapillary gallbladder stenting is effective in such patients, technical success is achieved in only 80% of acute cholecystitis cases [3]. We describe a safe cutting technique after temporary ENGBD for acute cholecystitis. A 92-year-old man with acute cholecystitis was admitted to our institution. We continued his anticoagulant therapy from another hospital owing to atrial fibrillation and brain infarction history. As the patient showed good performance status, we planned elective laparoscopic cholecystectomy after local inflammation and general condition improvement by gallbladder drainage. We performed ENGBD using a 6-Fr pigtail-type nasobiliary drainage tube (Olympus Medical Systems, Tokyo, Japan) without sphincterotomy (Fig. 1a,b; Video S1). The procedure was successful without adverse events and the symptoms disappeared. However, after 2 days, brain infarction occurred. Cholecystectomy was deemed inappropriate in the acute phase of brain infarction. Therefore, drainage tube cutting using scissors forceps (FS-5/L-1, Olympus Medical Systems) was performed. A side-viewing endoscope was inserted in the stomach, and the drainage tube was confirmed. The tube was pressed against the gastric wall to fix the position and cut off (Fig. 2a–c; Video S2). The diameter of the 6-Fr drainage tube was relatively large compared with the distance of the fully opened scissors forceps. Therefore, the cutting procedure required three attempts (7 min). Finally, the tube stump