Endoscopic naso-gallbladder drainage by using cholangioscopy for acute cholecystitis combined with cholangitis or choledocholithiasis (with video)

Abstract

P Acute cholecystitis is one of the most frequent emergency situations, and laparoscopic cholecystectomy within 72 hours is the treatment of choice. However, cholecystectomy has a significant morbidity and mortality rate in elderly people with severe comorbidities and in patients who are poor surgical candidates such as those with sepsis, liver cirrhosis, thrombocytopenia, and coagulopathies.3-6 Percutaneous cholecystostomy (PC) is an alternative to surgery in these high-risk patients. Although PC is a simple procedure, there are several complications including hemorrhage, liver hematoma, hemobilia, bile leak, pneumothorax, and catheter dislodgment. The complication rate of PC ranges from 9% to 27% and increases in patients with bleeding tendency or a large amount of ascites.7-10 Endoscopic transpapillary gallbladder drainage has been used when the percutaneous approach is contrain-