Endoscopic naso-gallbladder drainage in the treatment of acute cholecystitis: alleviates inflammation and fixes operator's aim during early laparoscopic cholecystectomy

Abstract

In 1984, Kozarek first reported the use of endoscopic retrograde cholangiopancreatography (ERCP) to perform selective cannulation of the cystic duct, and since then this procedure has also been reported by others. With this procedure, disorders in the gallbladder can be examined in detail, using, for example, selective cytology, and drainage for acute cholecytitis can also be performed. With this procedure, we were able to successfully perform early laparoscopic cholecystectomy (LC). Although surgery is often problematic in patients with acute cholecystitis because of inflammation, making Callot's triangle difficult to distinguish, the use of endoscopic naso-gallbladder drainage (ENGBD) during surgery enables us to identify the cystic duct for catheter cannulation. We performed early LC for acute cholecystitis in 18 of 22 patients, while 18 other patients underwent open cholecystectomy during the same period (retrospective study). These two groups were then compared. The LC group had shorter pre- and postoperative periods and shorter hospitalization (P < 0.05). ENGBD resulted in very little bleeding. None of the ENGBD patients required conversion to open surgery, whereas 11.1% of the non-ENGBD patients were converted. ENGBD was successfully employed in 18 of the initial 22 (81.8%) patients. The favorable points in using ENGBD with LC were that (i) the gallbladder inflammation was alleviated even if patients had ascites, and (ii) use of ENGBD normally improved visualization and made cystic duct identification easier. However, if ERCP cannot be carried out, the performance of ENGBD must also be ruled out.